Pediatric Research最新文献

{"title":"Early development of cortical networks is modulated by Family Nurture Intervention: a multicenter replication study.","authors":"Pauliina Yrjölä, Michael M Myers, Robert J Ludwig, Martha G Welch, Sampsa Vanhatalo, Anton Tokariev","doi":"10.1038/s41390-026-05432-3","DOIUrl":"https://doi.org/10.1038/s41390-026-05432-3","url":null,"abstract":"<p><strong>Background: </strong>Prematurity is associated with a high risk of abnormal neurodevelopment, inflicting life-long neurocognitive consequences with major public health importance. This calls for early biomarkers of functional brain development to serve as indicators of the effect of environmental enrichment in neonatal intensive care units (NICU).</p><p><strong>Methods: </strong>Here, we studied whether the previously found functional brain network effects of Family Nurture Intervention (FNI) are replicated in an independent trial, and when these effects arise in early brain development. We compared networks in infants following FNI treatment to infants receiving standard NICU care (SC) and to term-born healthy controls (HC).</p><p><strong>Results: </strong>We found that the prior network results, i.e. decrease in the strength of phase-based networks of FNI infants, replicated fully within the same site and partially at an external validation site. Moreover, longitudinal tracking of cortical networks disclosed an early divergence of trajectories between FNI and SC groups during the preterm period, resulting in no detectable difference in the functional networks of FNI and HC infants at term age, while the corresponding networks of SC infants showed significant difference.</p><p><strong>Conclusion: </strong>The findings together support the idea that FNI may modulate early developmental trajectories of cortical networks and mitigate effects of prematurity.</p><p><strong>Impact: </strong>Previously reported brain network effects of Family Nurture Intervention (FNI) replicated fully in an independent trial within the same site and partially at an external validation site. Developmental analysis revealed that FNI lead infants to a different trajectory of brain development compared to infants receiving standard care, resulting in no detectable difference in their functional networks compared to healthy term-born counterparts at term age. The findings together support the idea that FNI may modulate early developmental trajectories of cortical networks and mitigate the effects of prematurity. FNI provides an accessible and cost-effective intervention with potentially substantial global impact.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888033","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 future of the pediatric research workforce: implications of an evolving fellowship training landscape.","authors":"Kimberly Montez, Elizabeth E Halvorson, Maya I Ragavan","doi":"10.1038/s41390-026-05459-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05459-6","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888116","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":"Insulin resistance in children: time to test the foundations.","authors":"Elaine Catherine Kennedy, Colin Patrick Hawkes","doi":"10.1038/s41390-026-05458-7","DOIUrl":"https://doi.org/10.1038/s41390-026-05458-7","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888101","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 gut-brain axis in IgA vasculitis with neurological involvement: from association to experimentally tractable hypotheses.","authors":"Qian Xu","doi":"10.1038/s41390-026-05492-5","DOIUrl":"https://doi.org/10.1038/s41390-026-05492-5","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888142","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":"Antimicrobial resistance patterns, molecular resistance prediction, and treatment outcomes in pediatric Helicobacter pylori infection.","authors":"Ying Chen, Zhangyu Gu, Mei Sun, Zhiqin Mao, Jing Guo","doi":"10.1038/s41390-026-05435-0","DOIUrl":"https://doi.org/10.1038/s41390-026-05435-0","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance increasingly complicates empirical treatment of pediatric Helicobacter pylori (H. pylori) infection. We examined resistance patterns and the relationship of molecular and culture-based results to treatment and eradication outcomes.</p><p><strong>Methods: </strong>We retrospectively studied children who underwent clinically indicated endoscopy with paired polymerase chain reaction (PCR) and culture testing between October 2022 and October 2024. Resistance-associated variants were identified by PCR and Sanger sequencing. Culture-positive isolates underwent antimicrobial susceptibility testing, which informed treatment selection. Eradication was assessed by carbon-13 urea breath testing.</p><p><strong>Results: </strong>Of 145 children, 128 (88.3%) were PCR positive and 92 were culture positive. Phenotypic resistance to clarithromycin (CLA), metronidazole (MTZ), and levofloxacin (LVX) was 82.6%, 81.5%, and 29.3%, respectively; 72.8% of isolates were resistant to at least two antibiotics. Molecular prediction of CLA nonsusceptibility had 98.8% sensitivity, 90.9% specificity, and 97.8% accuracy; corresponding values for LVX were 90.9%, 97.7%, and 95.5%. Eradication was achieved in 86 of 97 treated children (88.7%), and 80 of 84 treated culture-positive children received phenotypically concordant regimens.</p><p><strong>Conclusion: </strong>CLA and MTZ resistance and multidrug resistance were frequent. Molecular analysis of 23S rRNA and gyrA complemented culture-based susceptibility testing in treatment selection.</p><p><strong>Impact: </strong>Clarithromycin and metronidazole resistance exceeded 80%, and nearly three quarters of the pediatric H. pylori isolates were resistant to at least two antibiotics, substantially limiting empirical treatment options. Molecular analysis of 23S rRNA and gyrA closely reflected phenotypic clarithromycin and levofloxacin nonsusceptibility, whereas molecular findings for other antibiotics were less readily interpretable. By linking molecular and culture-based resistance results with the regimens prescribed and subsequent eradication outcomes, this study shows how the two approaches can complement each other in routine pediatric care.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888008","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":"Prediction of retinopathy of prematurity using machine learning models.","authors":"Tapas R Padhi, Naresh Nelaturi, Manoj Teltumbade, Jagannadha Ganti, Venkat N Peri, Satya P Rani, Govind Vishnoi, Sheena Gill, Saroj K Sutar, Souvik Bhunia, Ratnabali Misra, Errol R Norwitz","doi":"10.1038/s41390-026-05413-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05413-6","url":null,"abstract":"<p><strong>Background: </strong>Early identification of neonates at risk of retinopathy of prematurity (ROP) is essential to prevent vision loss. The goal of this study was to develop, test, and validate machine learning (ML) models to predict which newborns will develop ROP and require treatment.</p><p><strong>Methods: </strong>A real-world, de-identified, clinical dataset including 23,404 medical records from 9205 individuals was abstracted, curated, and processed from 25 newborn care units in Odisha, India. A sequential two-step strategy was used: STEP 1 used demographic, perinatal, laboratory, and NICU variables to predict the development of any form of ROP; STEP 2 incorporated structured findings from specialist ophthalmic examinations, including stage, zone, plus/pre-plus status, and related severity descriptors, to identify which ophthalmically assessed infants would require treatment for ROP. The models used structured clinical variables rather than raw retinal images. Eight ML models were trained and tested for each step. Model performance was evaluated prospectively in a separate cohort from the same population.</p><p><strong>Results: </strong>The highest-performing models were Random Forest for STEP 1 and LightGBM for STEP 2. In the prospective validation cohort from the same population, the sequential framework had 84.9% sensitivity (437/515) for treatment-requiring ROP; 78 treatment-requiring infants were not identified.</p><p><strong>Conclusion: </strong>The sequential framework shows promise as a structured-data, workflow-aligned approach for risk stratification in a resource-constrained public-health setting. Its current performance supports further development as adjunctive prioritization support within existing guideline-based screening pathways; model outputs should not be used to defer specialist ophthalmic assessment without additional threshold optimization, calibration, external validation, and implementation testing.</p><p><strong>Impact: </strong>Early identification of neonates at risk of retinopathy of prematurity (ROP) is essential to prevent vision loss. We developed a two-step machine learning framework using a real-world clinical dataset of 23,404 records from 9205 infants. In a prospective validation cohort, the sequential framework had 84.9% sensitivity (437/515) for treatment-requiring ROP. These findings define the framework's role as adjunctive risk-stratification and prioritization support within existing guideline-based screening pathways; model output should not be used to defer indicated ophthalmic examinations. With further model optimization, such a staged approach may help resource-constrained networks prioritize referrals while preserving the safety net of routine screening.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888083","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":"A child's quiet revolution.","authors":"Azhar Ilham Haliwungan","doi":"10.1038/s41390-026-05449-8","DOIUrl":"https://doi.org/10.1038/s41390-026-05449-8","url":null,"abstract":"<p><p>This poem explores the paradox at the heart of pediatric care: although children represent humanity's greatest biological vulnerability, they remain its most profound source of hope. Through images of neonatal wards, parental devotion, and life-sustaining technologies, the poem juxtaposes medical progress with the enduring uncertainty that accompanies childhood illness. Rather than celebrating scientific achievement alone, it argues that the true measure of civilization lies in how compassion, dignity, and collective responsibility are extended to its youngest lives. Ultimately, the poem reframes survival not merely as a clinical outcome but as a moral achievement, suggesting that every child's heartbeat quietly reshapes our collective future.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881308","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 post-NICU human milk intake on respiratory outcomes in bronchopulmonary dysplasia.","authors":"Carol Cao, Joseph M Collaco, Gangaram G Akangire, Dustin Anderson-Bell, Eric D Austin, Anita Bhandari, Julie L Fierro, Lystra P Hayden, Jelte Kelchtermans, Khanh V Lai, Winston Manimtim, Audrey N Miller, Paul E Moore, Leif D Nelin, Jessica L Rice, Catherine A Sheils, Roopa Siddaiah, Michael C Tracy, Steven H Abman, Christopher D Baker, Carolyn Dress, Melissa A House, Nicole Stephenson, Amit Agarwal, Sharon A McGrath-Morrow, Brianna C Aoyama","doi":"10.1038/s41390-026-05438-x","DOIUrl":"https://doi.org/10.1038/s41390-026-05438-x","url":null,"abstract":"<p><strong>Background: </strong>To assess whether human milk consumption after neonatal intensive care unit (NICU) discharge is associated with outpatient respiratory outcomes in infants and children with bronchopulmonary dysplasia (BPD).</p><p><strong>Methods: </strong>We conducted a retrospective longitudinal cohort study of children under 2 years followed in outpatient BPD clinics. Participants were categorized by post-NICU human milk exposure (any vs. none). Caregiver questionnaires assessed the presence and frequency of chronic respiratory symptoms and acute care usage. Baseline characteristics were compared descriptively, and logistic regression with clustering by subject evaluated associations between human milk intake and outcomes.</p><p><strong>Results: </strong>Among 1731 children, 445 (25.7%) received human milk after NICU discharge, and 1286 (74.3%) did not. After adjusting for potential confounders, human milk consumption was associated with lower odds of sick (OR: 0.65, p = 0.006) and emergency department visits (OR: 0.66, p = 0.015), antibiotic (OR: 0.58, p = 0.005) and steroid prescriptions (OR: 0.46, p < 0.001), and beta-agonist use in the prior 3 months (OR: 0.69, p = 0.008).</p><p><strong>Conclusions: </strong>In our multicenter cohort of children with BPD, post-NICU human milk consumption was associated with decreased parent-reported acute healthcare utilization and chronic respiratory symptoms, supporting its role as a modifiable risk factor that may improve respiratory outcomes in children with BPD.</p><p><strong>Impact: </strong>Human milk has been shown to decrease the incidence of bronchopulmonary dysplasia (BPD); however, limited data exist on the role of human milk intake after NICU discharge and its effect on long-term outpatient respiratory outcomes. Our findings demonstrate that post-NICU human milk intake is associated with decreased acute care usage and chronic respiratory symptoms in children with BPD, suggesting that human milk consumption is potentially a modifiable risk factor to improve outcomes. Further investigation using quantitative time-adjusted analyses, evaluating long-term respiratory consequences, and addressing barriers to use is needed to better define the role of human milk in this population.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881340","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":"Factors associated with ventriculoperitoneal shunt conversion and intraparenchymal hemorrhage following ventriculosubgaleal shunt for post-hemorrhagic ventricular dilatation.","authors":"Vanessa Krohn, Emilie Groulx-Boivin, Christine Saint-Martin, Raed Abuazzah, Marc Beltempo, Roy Dudley, Jarred Garfinkle","doi":"10.1038/s41390-026-05431-4","DOIUrl":"https://doi.org/10.1038/s41390-026-05431-4","url":null,"abstract":"<p><strong>Background: </strong>Post-hemorrhagic ventricular dilatation (PHVD) is often managed with temporizing measures like ventriculosubgaleal shunts (VSGS). We aimed to identify factors associated with (1) ventriculoperitoneal shunt (VPS) conversion and (2) intraparenchymal hemorrhage (IPH) following VSGS.</p><p><strong>Methods: </strong>Retrospective cohort study of infants born ≤34 gestational age (GA) with PHVD managed with VSGS between 2012-2024. Clinical and imaging characteristics were compared between infants with and without VPS conversion and between infants with and without post-VSGS IPH.</p><p><strong>Results: </strong>Forty-two infants received VSGS. Compared to neonates without VPS (n = 7), those who received a VPS (n = 35) had lower GA at birth (mean 27.5 weeks [SD3.0] vs. 30.1 weeks [2.0], p = 0.029) and larger ventricular size ipsilateral to the catheter immediately after intervention (median ventricular index [mm above p97] 1.3 mm vs. -1.7 mm, p = 0.048, and median anterior horn width 6.5 mm vs. 3.7 mm, p = 0.022). IPH occurred in 9/42 (21%) infants following VSGS and no risk factors were identified.</p><p><strong>Conclusion: </strong>Greater GA and smaller post-VSGS ventricular size were associated with lower rates of VPS conversion. Post-VSGS IPH was common, but the absence of associated factors suggests a heterogenous pathophysiology. Future work should focus on refining temporizing strategies to reduce VPS dependence and characterize the spectrum and pathogenesis of post-VSGS IPH.</p><p><strong>Impact: </strong>Greater gestational age at birth and smaller post-VSGS shunt ventricular size were associated with a lower likelihood of ventriculoperitoneal shunt conversion Post-VSGS intraparenchymal hemorrhage was common and exhibited topographic and morphologic heterogeneity. No risk factors for post-VSGS intraparenchymal hemorrhage were identified. The findings underscore the need to refine temporizing strategies in post-hemorrhagic ventricular dilatation to reduce ventriculoperitoneal shunt dependency and complications.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881295","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":"Floods and droughts and pediatric malnutrition in low-income countries: a systematic review and meta-analysis.","authors":"Adriano La Vecchia, Eleonora Borrione, Benedetta Esposito, Mattia Baglioni, Carlo Agostoni, Cristiana Berti, Anna Comotti","doi":"10.1038/s41390-026-05411-8","DOIUrl":"https://doi.org/10.1038/s41390-026-05411-8","url":null,"abstract":"<p><strong>Background: </strong>This study systematically reviewed and meta-analyzed the prevalence and risk of child malnutrition following extreme weather events in low- and lower-middle-income countries.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, and Cochrane Library for studies assessing child stunting, wasting, underweight, or overweight/obesity after extreme weather events. Random-effects models were used to pool prevalence and association estimates, with subgroup and sensitivity analyses by event type. Risk of bias was assessed using tools appropriate to study design.</p><p><strong>Results: </strong>Twenty-six studies, including over 320,000 children met the inclusion criteria, focusing exclusively on floods and/or droughts; none addressed overweight/obesity. The pooled prevalence of stunting, wasting, and underweight following extreme weather events was 39% (95% CI: 31-48%), 19% (95% CI: 12-28%), and 42% (95% CI: 22-64%), respectively. Wasting prevalence was higher after droughts than floods (22% vs. 13%, p = 0.04), while stunting did not differ by event type (p = 0.68). Meta-analyses revealed no significant long-term association between extreme weather events and stunting, though a transient increase in risk was observed within three months of flood exposure.</p><p><strong>Conclusions: </strong>Child malnutrition remains highly prevalent in these settings. The complex climate-malnutrition link underscores the need for standardized exposure definitions and robust nutritional surveillance.</p><p><strong>Impact: </strong>This meta-analysis provides the first pooled prevalence estimates of wasting, stunting, and underweight after droughts and floods-19%, 39%, and 42%, respectively. Wasting was significantly higher following droughts than floods, suggesting possible climate- and geography-specific nutritional associations. Evidence linking extreme weather events to pediatric malnutrition in low- and lower-middle-income countries remains limited and inconsistent. Findings highlight major research gaps and the need for standardized definitions, baseline data, and climate-resilient nutrition strategies.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881330","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}