Pediatric Research最新文献

{"title":"Flat lines in survival from out-of-hospital pediatric cardiac arrest: making the case for bold reform in prehospital care and resuscitation.","authors":"Kendall J Donohue, Andrew M Fine","doi":"10.1038/s41390-025-04477-0","DOIUrl":"https://doi.org/10.1038/s41390-025-04477-0","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239365","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":"Pumpless arteriovenous extracorporeal membrane oxygenation for 2000 g newborns with respiratory failure: proof of principle data from a preterm lamb model.","authors":"Haruo Usuda, Hideyuki Ikeda, Shimpei Watanabe, Erin L Johnson, Sean W D Carter, Yusaku Kumagai, Yuya Saito, Michelle Kay Yi Seah, Noriyoshi Mochi, Kantarou Sahara, Hannah Rs Watson, Agnihotri Biswas, Zubair Amin, Sebastian E Illanes, Shinichi Kawamura, Masatoshi Saito, Matthew W Kemp","doi":"10.1038/s41390-025-04429-8","DOIUrl":"https://doi.org/10.1038/s41390-025-04429-8","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for neonates with severe respiratory failure; however, its use in preterm infants is limited by anatomical and physiological constraints. We investigated the feasibility of pumpless arteriovenous ECMO (AV-ECMO) in sub-2000 g premature lambs unresponsive to mechanical ventilation.</p><p><strong>Methods: </strong>Nineteen preterm lambs at 119 days' gestational age (mean birth weight 1.9 kg) were allocated to either a control group (n = 9) or an AV-ECMO group (n = 10). Physiological, biochemical, and ultrasound parameters were monitored over 48 h. Circuit flow rates and plasma biomarkers were assessed, and ductus arteriosus patency was evaluated using ultrasound.</p><p><strong>Results: </strong>Nine out of ten AV-ECMO animals that were unresponsive to ventilation support survived a predetermined planned 48-hour study period. AV-ECMO enabled successful withdrawal of mechanical ventilation while maintaining critical physiological parameters, including heart rate, mean arterial pressure, pH, and lactate levels. A strong positive correlation was observed between DA diameter and total circuit flow (r = 0.775, p < 0.001).</p><p><strong>Conclusions: </strong>This study demonstrates the feasibility of pulsatile, pumpless AV-ECMO using small catheters in premature lambs at or below 2 kg in weight with severe respiratory failure. Further studies are warranted to assess long-term outcomes.</p><p><strong>Impact: </strong>This study presents the first successful demonstration of pumpless arteriovenous ECMO using small catheters in premature lambs unresponsive to ventilation. This study demonstrates the feasibility of pump-free ECMO in neonates previously considered too small or fragile for conventional ECMO. Further refinement of this approach, along with additional trials, has the potential to improve survival in this vulnerable population.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239387","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":"Misinformation and disinformation undermine progress in pediatric research: challenges and solutions.","authors":"Mark R Schleiss, Lee Beers, Lisa J Chamberlain, Sangeeta Hingorani, Henry C Lee, Scott A Lorch, Pooja Tandon, Cindy W Christian","doi":"10.1038/s41390-025-04370-w","DOIUrl":"https://doi.org/10.1038/s41390-025-04370-w","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239380","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":"White matter microstructure and gray matter density in 12-year-old preterm born children.","authors":"Annette Karimi, Ylva Fredriksson Kaul, Olga Kochukhova, Martin Johansson, Cecilia Montgomery, Markus Fahlström, Sven Haller, Lena Hellström-Westas, Johan Wikström","doi":"10.1038/s41390-025-04451-w","DOIUrl":"https://doi.org/10.1038/s41390-025-04451-w","url":null,"abstract":"<p><strong>Background: </strong>To investigate white matter microstructure and gray matter densities in 12-year-old children born very preterm and evaluate potential effects of antenatal steroids and intraventricular hemorrhage (IVH).</p><p><strong>Methods: </strong>Brain MRI (3Tesla) was performed in 57 children born very preterm, 16 with IVH and 41 treated with antenatal corticosteroids, and in 22 full-term controls. White matter microstructure and gray matter density were compared between groups using tract-based spatial statistics (TBSS) and voxel-based morphometry (VBM).</p><p><strong>Results: </strong>Preterm-born children showed no differences in white matter fractional anisotropy (FA) compared to controls, but showed increased or decreased gray matter density in several regions. In the preterm group, lower gestational age was associated with reduced FA in the anterior commissure and the anterior parts of the inferior fronto-occipital fasciculus. Antenatal steroid exposure did not affect FA or gray matter density. IVH was associated with decreased gray matter density in the temporo-occipital cortex.</p><p><strong>Conclusion: </strong>Very premature birth is associated with alterations in gray matter density, and there is a correlation between gestational age and white matter integrity. Antenatal steroid exposure does not affect white matter integrity or gray matter density, but IVH exposure is associated with locally decreased gray matter density.</p><p><strong>Impact: </strong>Prematurely born adolescents show differences in gray matter density in several regions compared to controls, with both increased and decreased values observed. In prematurely born adolescents, there is a correlation between lower gestational age and reduced white matter integrity. Assessment of white matter microstructure using tract-based spatial statistics (TBSS) and gray matter volumes using voxel-based morphometry (VBM) in the same cohort of subjects shows alterations in regions involving the same neural circuit.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239446","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":"Comparison of vasopressin to epinephrine during pediatric in-hospital cardiac arrest: survival and physiologic responsiveness.","authors":"Morgann Loaec, Garrett Keim, Kathryn Graham, Martha F Kienzle, Amanda O'Halloran, Lindsay N Shepard, Sanjiv Mehta, Samridhi Sawhney, Marion Donoghue, Kellimarie Cooper, Todd J Kilbaugh, Vinay Nadkarni, Alexis A Topjian, Robert A Berg, Robert M Sutton, Ryan W Morgan","doi":"10.1038/s41390-025-04374-6","DOIUrl":"https://doi.org/10.1038/s41390-025-04374-6","url":null,"abstract":"<p><strong>Aim: </strong>To compare post-epinephrine vasopressin administration versus epinephrine and time to return of spontaneous circulation (ROSC) during pediatric in-hospital cardiac arrest (IHCA), and explore vasopressin's physiologic effects.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study (2017-2023) compared vasopressin patients who received ≥1 dose of preceding epinephrine and matched epinephrine-only patients based on age, illness category, and preceding epinephrine dosing. Time to ROSC was analyzed using Cox regression. Vasopressor response was defined as ≥5 mmHg increase in diastolic blood pressure (DBP).</p><p><strong>Results: </strong>Forty-one matched pairs were analyzed. Median CPR duration was 36.5 [IQR 23, 48] minutes; median time to dose was 14.5 [10.8, 19] minutes. ROSC occurred in 10/41 (24%) vasopressin and 15/41 (36%) epinephrine patients (p = 0.34) with no difference in time to ROSC (aHR 0.73 [95% CI: 0.31-1.7]). Vasopressor response occurred in 4/12 (33%) vasopressin and 1/7 (14%) epinephrine patients (p = 0.60). Regression discontinuity analysis demonstrated a change in DBP of +2.3 mmHg after vasopressin (95% CI: -11.4, 16.0) and -5.67 mmHg after epinephrine (-15.13, 3.80).</p><p><strong>Conclusion: </strong>No significant differences were found in time to ROSC or DBP increase between vasopressin and epinephrine given late during CPR. A subset of vasopressin responders suggests further research on intra-arrest DBP response to vasopressin is needed.</p><p><strong>Impact: </strong>The use of intra-arrest vasopressin is an understudied topic in pediatric cardiac arrest. This study presents a unique comparison of ongoing epinephrine to vasopressin administration, using dose matching to address the limitations of our current vasopressin use. We present a novel analysis of physiologic response to vasopressin using the change in diastolic blood pressure.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228492","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":"Respiratory syncytial virus in infants ≤2 months in the post-COVID-19 pandemic era: shifting patterns and outcomes.","authors":"Spyridon Karageorgos, Ioannis Koutroulis","doi":"10.1038/s41390-025-04471-6","DOIUrl":"https://doi.org/10.1038/s41390-025-04471-6","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225704","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":"Magnetic resonance imaging and spectroscopy in neonatal encephalopathy: current consensus position and future opportunities.","authors":"Abbot Laptook, Aisling A Garvey, Caroline Adams, Patricia Ellen Grant, Eleanor J Molloy, Floris Groenendaal, Lauren C Weeke, Manon Benders, Misun Hwang, Mohamed El-Dib, Nadia Badawi, Nicola J Robertson, Raymand Pang, Sudhin Thayyil, Terrie Inder, Ted Carl Kejlberg Andelius, Kasper Jacobsen Kyng","doi":"10.1038/s41390-025-04448-5","DOIUrl":"https://doi.org/10.1038/s41390-025-04448-5","url":null,"abstract":"<p><p>Neonatal encephalopathy (NE) is a significant global health concern. It is a leading cause of long-term neurodevelopmental impairment, with hypoxic-ischaemic perinatal brain injury being the most common underlying contributor. Although therapeutic hypothermia has reduced mortality and improved outcomes for some affected infants, many survivors experience neurodevelopmental disability, including cerebral palsy and/or deficits in cognition, behaviour, and executive functioning. Early and accurate prognostication and identification of injury severity remain a challenge due to evolving clinical signs and multiple etiologies. Magnetic resonance imaging (MRI) is the gold standard for characterizing NE-related brain injury. Diffusion-weighted imaging (DWI) enables early detection of injury, and proton magnetic resonance spectroscopy (¹H-MRS), specifically the Lac/NAA peak area ratio from basal ganglia and thalamus, provides robust prognostic indicators of two-year neurodevelopmental outcomes. MRI scoring systems incorporating multiple modalities correlate well with later neurodevelopmental outcomes. Advanced imaging modalities, such as diffusion tensor imaging (DTI), arterial spin labelling (ASL), and blood oxygen level-dependent (BOLD) imaging, offer further insights into microstructural integrity, perfusion, and functional connectivity. By standardizing acquisition protocols and post-processing, MRI biomarkers can serve as reliable, early surrogate endpoints in neuroprotection trials, allowing smaller sample sizes and accelerating clinical translation. MRI and ¹H-MRS integration enhances prognostication, guides clinical management, and supports informed decision-making in NE care. IMPACT: This article highlights the importance of state-of-the-art MRI and MRS techniques for assessing neonatal encephalopathy (NE), emphasizing optimized protocols, accurate interpretation, and the use of MRI scoring systems to enhance clinical decision-making. It provides a comprehensive guide to advanced MRI/MRS acquisition and interpretation in neonates with NE, addressing current limitations and future directions. By optimizing neonatal MRI/MRS practices, this work aims to improve early diagnosis and prognostication, guide treatment strategies, and ultimately improve the management of neonates with NE.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225740","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":"Bleomycin Electrosclerotherapy (BEST) for treatment of slow-flow vascular malformations in children.","authors":"Constantin Goldann, Anna Deleu, Marie Sophie Schüngel, Julius H Loeser, Alena Akinina, Moritz Guntau, Moritz Wildgruber, Vanessa F Schmidt, Walter A Wohlgemuth, Richard Brill","doi":"10.1038/s41390-025-04455-6","DOIUrl":"https://doi.org/10.1038/s41390-025-04455-6","url":null,"abstract":"<p><strong>Background: </strong>This prospective study evaluates the effectiveness and safety of Bleomycin electrosclerotherapy (BEST) for treating slow-flow vascular malformations in a pediatric cohort. While retrospective studies have reported its efficacy, prospective data in pediatric populations are limited.</p><p><strong>Methods: </strong>30 pediatric patients (mean age: 9.5 years) with venous, veno-lymphatic, or capillary-veno-lymphatic malformations were enrolled in the study between 2020 and 2021 and received at least one BEST treatment. Follow-up continued through 2024 (mean: 25 months). MRI volumetry and clinical evaluation were performed at each follow-up.</p><p><strong>Results: </strong>A total of 58 sessions (mean: 1.81 per patient) led to a median lesion volume reduction from 232 cm³ (range: 1.69 cm³-9814.12 cm³) pre-treatment to 41 cm³ (range: 0.57 cm³-1789.63 cm³) after the final session, corresponding to mean relative volume reduction of 59.4%. Symptoms resolved in 2 patients, improved in 18, and remained unchanged in 4. Minor side effects included skin hyperpigmentation (n = 6), inflammation (n = 3), temporary motion restriction (n = 1), and lymphorrhea (n = 1). No serious complications were observed.</p><p><strong>Conclusion: </strong>BEST is a safe, effective treatment for pediatric slow-flow malformations, achieving lesion reduction and symptom relief. Future studies are warranted to optimize treatment protocols and establish long-term benefits.</p><p><strong>Impact statement: </strong>Bleomycin Electrosclerotherapy (BEST) is a safe and effective treatment for slow-flow vascular malformations in pediatric patients, achieving lesion volume reduction and symptom improvement. The study assesses BEST exclusively in a pediatric cohort using standardized MRI-based volumetry alongside clinical outcomes. BEST can be effective not only in refractory cases but also as a first-line or early-line treatment option, broadening its potential indications. By indicating a cumulative therapeutic benefit of repeated BEST sessions, the study encourages further investigations into tailored, session-based treatment strategies for large or progressive malformations.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225679","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":"Renal replacement therapy in the neonatal intensive care unit: balancing neonatal expertise with practicality - Proceedings from the First International Neonatal Nephrology Symposium.","authors":"Samantha R Schwartz, Kim T Vuong, Evelyn Obregon, Matko Marlais, Michelle Starr, David Askenazi","doi":"10.1038/s41390-025-04478-z","DOIUrl":"https://doi.org/10.1038/s41390-025-04478-z","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225697","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":"Ureaplasma parvum and Ureaplasma urealyticum induce distinct types of inflammation in neonates and human epithelial cell models.","authors":"Hongzhen Zhu, Pol Oliveras-Julià, Gea F Hasperhoven, Luca L van Leeuwen, Ad C J M de Bruijn, Marijn C Verwijs, Annemarie M C van Rossum, René F Kornelisse, Kim Stol, Wendy W J Unger","doi":"10.1038/s41390-025-04415-0","DOIUrl":"https://doi.org/10.1038/s41390-025-04415-0","url":null,"abstract":"<p><strong>Background: </strong>Development of bronchopulmonary dysplasia (BPD) in premature neonates is associated with infection and inflammation. Both Ureaplasma parvum and Ureaplasma urealyticum are associated with BPD. We examined whether there is a difference in pathogenicity between the two species METHODS: Tracheal aspirates of 25 preterm neonates were analyzed for bacterial presence and inflammatory mediators. Alveolar epithelial cells were infected with U. parvum and U. urealyticum strains to assess inflammatory mediators, cell death and oxidative stress.</p><p><strong>Results: </strong>U. parvum was detected in 2/25 and U. urealyticum in another 3/25 neonates. E. coli was co-detected in 3/5 Ureaplasma-positive samples. U. parvum-positive samples contained high IL-6, IL-8 and CXCL5. U. urealyticum-positive samples also contained high IL-6 and IL-8, but low CXCL5, and high CXCL1 and CCL2. Five-to-ten-fold higher IL-6 and two-fold higher IL-8 levels were detected in U. parvum-infected cell cultures than U. urealyticum, whereas apoptotic cell death was detected in U. urealyticum-infected cultures. Infection with both species induced ROS.</p><p><strong>Conclusion: </strong>Both Ureaplasma species may contribute to inflammation and cell damage, via oxidative stress, as observed in BPD, yet through different mechanisms. U. parvum infection induces a strong pro-inflammatory mediator response in alveolar epithelial cells while U. urealyticum infection results in cell death.</p><p><strong>Impact: </strong>U. urealyticum and U. parvum can contribute to the inflammation and cell damage seen in chronic lung disease through the secretion of inflammatory mediators. The two species differ in their mechanism of action: U. parvum infection induces a strong pro-inflammatory mediator response in alveolar epithelial cells while U. urealyticum infection results in epithelial cell death. Our data provide new insights into the role of Ureaplasma in the development of chronic lung disease in premature infants.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225725","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}