Pediatric Research最新文献

{"title":"Continuous EEG monitoring after neonatal cardiac surgery: seizure incidence and prognostic background abnormalities.","authors":"Reilly Philliben, Jennifer Keene, Kathleen Campbell, Amanda Sandoval Karamian, Betsy Ostrander, Reilly Hobbs, Chanelle Stidham, Brent Kay, Kristi Glotzbach","doi":"10.1038/s41390-026-05048-7","DOIUrl":"https://doi.org/10.1038/s41390-026-05048-7","url":null,"abstract":"<p><strong>Background: </strong>Neonates undergoing cardiac surgery are at risk for neurologic injury, but seizure incidence under current practices is unclear. Continuous electroencephalography (cEEG) enables real-time monitoring, yet its prognostic role remains understudied. This study examines seizure incidence and the relationship between cEEG background features, perioperative factors, and neurobehavioral outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study of 104 term and late-preterm neonates who underwent cardiac surgery with cardiopulmonary bypass. All patients received 48 h of postoperative cEEG. Interburst interval (IBI) severity was assessed at 24 and 48 h. Outcomes included complications, mortality, and attention scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS).</p><p><strong>Results: </strong>Seizure incidence was 1.9% (2/104). Excessive discontinuity was common: 52% showed moderate or severe IBI prolongation at 24 h. At 48 h, severe IBI was associated with increased risk of major complications (RR 6.1, 95% CI 2.7-14.2), mortality (RR 5.4, 95% CI 2.4-11.9), and abnormal attention scores (RR = 3.8, 95% CI 1.7-8.3).</p><p><strong>Conclusion: </strong>Seizures were rare, but excessive discontinuity was common and correlated with adverse outcomes. These findings highlight the prognostic value of cEEG background features beyond seizure detection and support routine postoperative monitoring in neonates undergoing cardiac surgery.</p><p><strong>Impact: </strong>Despite rare seizures, moderate to severe EEG discontinuity was prevalent following neonatal cardiac surgery. Prolonged interburst intervals postoperatively were associated with a higher incidence of complications and mortality. Severity of discontinuity also correlated with lower attention scores on standardized neurobehavioral assessment. This study highlights the prognostic utility of postoperative continuous EEG background features, reinforcing its value beyond seizure detection. Incorporating these EEG markers could improve early risk stratification and guide targeted neuroprotective interventions in this high-risk population.</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":"147841508","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":"Value of anti-N-methyl D-aspartate receptor in children with encephalitis: a prospective observational study.","authors":"Nagwan Y Saleh, Wafaa M Abo El Fotoh, Sameh A Abd El-Naby, Shimaa E Soliman, Zeinab S Abouzouna, Noha M Ashour","doi":"10.1038/s41390-026-04967-9","DOIUrl":"https://doi.org/10.1038/s41390-026-04967-9","url":null,"abstract":"<p><strong>Background: </strong>Anti-N-methyl D-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disorder increasingly recognized in children. We aimed to evaluate cerebrospinal fluid (CSF) anti-NMDAR antibody levels in pediatric encephalitis, and to assess their diagnostic and prognostic utility in relation to clinical, laboratory, and neuroimaging features METHODS: In this prospective observational study, 85 children with encephalitis admitted to the pediatric intensive care unit were evaluated. Patients were categorized into Group I (n = 37) with anti-NMDAR encephalitis and Group II (n = 48) with non-anti-NMDAR encephalitis. Clinical manifestations, CSF findings, Electroencephalogram (EEG), and CSF anti-NMDAR antibody levels (measured by ELISA) were analyzed. Receiver operating characteristic (ROC) curves assessed diagnostic performance RESULTS: Group I demonstrated significantly higher rates of psychiatric symptoms, seizures, abnormal movements, and speech disturbances than Group II. EEG abnormalities, particularly extreme delta brush, were more common in anti-NMDAR encephalitis. CSF anti-GluN1 antibody levels correlated positively with alanine aminotransferase(ALT), platelet count, and Glasgow Coma Scale score (GCS), and negatively with CSF neutrophils and protein. Antibody levels were significantly elevated in Group I, with ROC analysis showing high sensitivity and specificity for diagnosis CONCLUSION: CSF anti-NMDAR antibody measurement is a robust diagnostic biomarker in pediatric encephalitis. Early detection may facilitate timely immunotherapy and improve outcomes.</p><p><strong>Impact: </strong>This study demonstrates that CSF anti-NMDAR antibody testing improves both the diagnosis and prognosis of pediatric encephalitis. Antibody positivity was associated with distinct clinical and neuroimaging features, supporting earlier recognition and initiation of immunotherapy. Incorporating antibody testing into pediatric practice may enhance patient outcomes and advance the management of autoimmune encephalitis in children.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840720","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":"Early-Life DNA methylation at TRIM6 and TTC23 promoters associates with respiratory infections at one year.","authors":"Karlie Edwards, Sarah M Merrill, Nicole L Letourneau, Chaini Konwar, Nicole Gladish, Julie L MacIsaac, Gerald F Giesbrecht, Piush Mandhane, Elinor Simons, Theo J Moraes, Meghan B Azad, Padmaja Subbarao, Stuart E Turvey, Kharah M Ross, Michael S Kobor","doi":"10.1038/s41390-026-04986-6","DOIUrl":"https://doi.org/10.1038/s41390-026-04986-6","url":null,"abstract":"<p><strong>Background: </strong>DNA methylation (DNAm) is a well-characterized epigenetic modification that serves as a predictive marker of disease risk across the lifespan. Given the rapid development of the first 1000 days, infancy represents a critical window for examining how pediatric epigenetic signatures may shape future health trajectories.</p><p><strong>Methods: </strong>Here, we examined associations between blood DNAm in 3-month-old infants from a Canadian birth cohort and the number of respiratory infections experienced between 12 and 18 months of age, hypothesizing that a potential epigenetic signature in early-life might be predictive of future risk.</p><p><strong>Results: </strong>We discovered eight CpG sites with increased DNAm in the promoter regions of two genes: TRIM6 and TTC23. Post hoc characterization suggested that the CpGs in TRIM6 might have functional relevance in CD4T cells. Further, both genes are involved with immune system regulation and respiratory function, processes directly relevant to the investigated health outcome: respiratory infections. Additionally, the associated CpGs in TRIM6 were replicated in a second Canadian birth cohort with similar characteristics, propensity-matched on number of respiratory infections and estimated cell type proportions.</p><p><strong>Conclusion: </strong>Together these findings illuminated the potential utility of DNAm as a predictor of future respiratory infections in pediatric populations.</p><p><strong>Impact: </strong>DNAm signatures in infancy may help predict later susceptibility to respiratory infections, highlighting early-life epigenetic marks as potential risk indicators. Our study identified differentially methylated CpGs within the promoter regions of only two genes, TRIM6 and TTC23, an uncommon pattern that may point to biologically meaningful regulation. These findings expand on existing EWAS literature by showing that persistent, biologically relevant DNAm differences can be detected across cohorts, underscoring their predictive potential for lifelong health outcomes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841541","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":"Interpreting the proteomic response to pediatric severe traumatic brain injury.","authors":"Ahmed Al Khalifah, Anne-Marie Guerguerian","doi":"10.1038/s41390-026-04988-4","DOIUrl":"https://doi.org/10.1038/s41390-026-04988-4","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841511","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":"Neonatal kidney injury in the hyperoxia-induced bronchopulmonary dysplasia mouse models: effect on morphology and biomarkers.","authors":"Fred Graumuller, Theesitha Srikanth, Divya T Rajendran, Xander Takada, Beamon Agarwal, Pragnya Das, Vineet Bhandari","doi":"10.1038/s41390-026-04925-5","DOIUrl":"https://doi.org/10.1038/s41390-026-04925-5","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants have reduced nephrons at birth and are exposed to hyperoxic environments. The objective was to examine the effects of hyperoxia on renal injury.</p><p><strong>Methods: </strong>We utilized a mouse model of experimental moderate (60% O₂)-severe (100% O₂) bronchopulmonary dysplasia (BPD), obtaining kidney tissue on postnatal day 14. The number of glomeruli, glomerulus length, and Bowman's capsule's length were recorded. Cell death and expression of multiple biomarkers were assessed.</p><p><strong>Results: </strong>Morphometric analyses showed a significant decrease in glomeruli in male and female mice from room air (RA) to 60% BPD. Bowman's capsule length was significantly increased from RA to 100% BPD in female kidneys. TUNEL staining, cleaved caspase 3, and 9 expression revealed significantly increased cell death in the kidneys in the moderate and severe BPD models. There was increased expression of Angiopoietin-2 in male kidneys of the moderate BPD group, whereas Angiopoietin-1 and vascular endothelial growth factor were decreased in female mice. In the moderate BPD model, there was upregulation of nuclear factor-kappa B, transforming growth factor-β1, interleukin (IL)-6, and IL-1β in male and female mice.</p><p><strong>Conclusion: </strong>We report here that there is significant renal injury and cell death in moderate and severe mouse models of experimental BPD.</p><p><strong>Impact: </strong>Neonatal kidneys are still developing at birth. Hyperoxia exposure to the whole mouse also impacts the developing neonatal kidney. There is significant renal injury in moderate and severe mouse models of experimental BPD. This includes morphometric changes in the kidney tissue and increased cell death. In addition, there are significant alterations in the expression of vascular and inflammatory biomarkers.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841456","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":"Use of respiratory oscillometry in infants: a scoping review.","authors":"Chiara Veneroni, Viraraghavan Vadakkencherry Ramaswamy, Diane M Gray, Raffaele L Dellacà, Anna Lavizzari, Abdul Kareem Pullattayil, Camilla Rigotti, Maria Luisa Ventura, Emanuela Zannin","doi":"10.1038/s41390-026-05014-3","DOIUrl":"https://doi.org/10.1038/s41390-026-05014-3","url":null,"abstract":"<p><p>We mapped the evidence on the use of respiratory oscillometry (RO) in infants through a scoping review of the literature. We conducted a systematic search of Medline, Embase, Cochrane Library, Web of Science, Google Scholar, Cochrane Controlled Register of Trials, and clinical trial registries from inception to 1st September 2025. We included documents on the use of RO in infants up to 1 year. We assessed risk of bias using the Risk of Bias In Non-randomised studies of Interventions (ROBINS-I) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Reporting adheres to the PRISMA extension for Scoping Reviews. We included 45 papers and 7 protocols. Five themes emerged: feasibility and methodology; RO for assessing pathological conditions and exposures; prognostication of respiratory outcomes; ability to evaluate treatment response in the neonatal intensive care (NICU); role in bronchodilator/bronchoconstrictor testing in infants with wheezing. RO was feasible and may be a reliable modality for epidemiological studies of early lung function determinants and long-term follow-up of infants. It may also support individualised respiratory care in the NICU, although it has been used primarily as a research tool in this setting. Wider adoption requires infant-specific devices, standardised methodologies, and reference values. IMPACT: This is the first comprehensive scoping review mapping the evidence on respiratory oscillometry in neonates and infants under one year of age. Respiratory oscillometry may be a reliable modality for long-term monitoring of lung function starting in infancy. Respiratory oscillometry may support individualised respiratory care and prognostication in the neonatal intensive care unit.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840651","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 importance of registries to improve care.","authors":"Peter Lachman, Salhab El Helou, Bharath Krishnappa, Vikram Datta","doi":"10.1038/s41390-026-05056-7","DOIUrl":"https://doi.org/10.1038/s41390-026-05056-7","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840683","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":"Opportunities for antenatal medical treatment of genetic conditions: the earlier, the better.","authors":"Diana W Bianchi","doi":"10.1038/s41390-026-05044-x","DOIUrl":"https://doi.org/10.1038/s41390-026-05044-x","url":null,"abstract":"<p><p>Advances in genomic technologies, particularly massively parallel sequencing of cell-free fetal DNA, have transformed prenatal screening and created opportunities for fetal therapies. First-tier screening for trisomy 21 (T21) now enables early identification of affected fetuses, raising the possibility of prenatal intervention. Down syndrome (DS) is increasingly recognized not only as a neurodevelopmental condition but also as an interferon-driven disorder of immune dysregulation. Preclinical studies using human cellular models and trisomic mice demonstrated abnormalities in oxidative stress and inflammatory pathways. Connectivity Map-guided identification of apigenin, a naturally occurring flavonoid, showed partial normalization of gene expression, reduced neuroinflammation, and improved hippocampal-dependent learning in a mouse model, supporting the concept that atypical fetal brain development in T21 may be modifiable. Parallel human studies have confirmed chronic hypercytokinemia and autoimmunity in DS, and postnatal treatment with JAK inhibitors has shown early clinical benefit. A similar therapeutic paradigm is emerging for cystic fibrosis, where noninvasive prenatal testing detects CFTR variants and highly effective CFTR modulators are increasingly used during pregnancy. Early reports suggest that in utero exposure may ameliorate fetal complications such as meconium ileus. Together, these advances support a framework in which selected genetic disorders may be treatable beginning in fetal life. IMPACT: Advances in engineering and computational science, coupled with new biological and genomic knowledge, have led to novel prenatal opportunities to improve child health and treat disease.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841471","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":"Diagnostic performance of lung ultrasound for detecting lung necrosis in children with community-acquired pneumonia.","authors":"Rehab Elmeazawy, Manal Zaki AbdElsamea, Eman Mohamed Elaskary, Mohammed Helmi Emara","doi":"10.1038/s41390-026-05026-z","DOIUrl":"https://doi.org/10.1038/s41390-026-05026-z","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the diagnostic value of lung ultrasound (LUS) in detecting lung necrosis in children with community-acquired pneumonia (CAP), and to determine the sensitivity of the modified Lung Ultrasound Score (m-LUScore) in diagnosing necrotizing pneumonia (NP).</p><p><strong>Methods: </strong>Children aged 2 months to 18 years hospitalized with CAP were prospectively enrolled. All participants underwent detailed clinical assessment, laboratory investigations (CBC, CRP), lung ultrasonography, serial chest radiographs, and chest CT when lung necrosis was suspected based on LUS or radiographic findings. The m-LUScore was recorded on the first and fifth days of admission.</p><p><strong>Results: </strong>Among 161 children fulfilling the inclusion criteria for CAP, 42 had necrotizing pneumonia and 119 had non-necrotizing pneumonia. On day 1, the mean m-LUScore was significantly higher in NP than in non-NP cases (15.05 vs. 11.27, p < 0.001). A similar difference was observed on day 5 (15.64 vs. 8.65, p < 0.001). Logistic regression analysis identified the m-LUScore on both days as an independent detector of necrotizing pneumonia.</p><p><strong>Conclusions: </strong>Lung ultrasound is a sensitive and practical diagnostic tool for identifying necrotizing pneumonia in children. The m-LUScore provides a simple, noninvasive, and cost-effective method for detecting lung necrosis, especially valuable in settings with limited access to CT imaging.</p><p><strong>Impact: </strong>Necrotizing pneumonia is a severe complication of community-acquired pneumonia in children, often requiring CT imaging for confirmation. LUS can serve as a reliable and noninvasive alternative to CT for early detection of necrotizing pneumonia in resource-limited settings. The modified Lung Ultrasound Score (m-LUScore) can independently detect necrotizing pneumonia as early as the first day of admission.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841450","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":"Correction: Efficacy, safety, route of administration of midazolam and diazepam for pediatric status epilepticus: systematic review, meta-analysis, and trial sequential analysis.","authors":"Ahmed Kertam, Nourhan Hatem, Omar Mahmood Al-Azzawi, Long H Tu, Ahmed Harb, Mohamed Sabri Hassanin, Israa Abdeen, Mariam Mostafa, Salma Allam, Mohamed Mostafa, Yehia Nabil","doi":"10.1038/s41390-026-05063-8","DOIUrl":"https://doi.org/10.1038/s41390-026-05063-8","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841476","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}