Pediatric Research最新文献

{"title":"Assessing bedside measures of autonomic nervous system dysregulation in the PICU.","authors":"Colleen M Badke, Michael S Carroll, Tricia R Pendergrast, Debra E Weese-Mayer, L Nelson Sanchez-Pinto","doi":"10.1038/s41390-024-03778-0","DOIUrl":"https://doi.org/10.1038/s41390-024-03778-0","url":null,"abstract":"<p><strong>Background: </strong>Autonomic nervous system (ANS) dysregulation is common during critical illness and is often measured using heart rate variability (HRV). It is unknown if other forms of ANS function, such as pupillary light reflex and thermoregulation, are altered in critically ill children. We aimed to determine whether automated pupillometry and delta (central-to-peripheral) skin temperatures were associated with HRV.</p><p><strong>Methods: </strong>In this prospective observational pilot, inclusion criteria were admission to the pediatric intensive care unit (ICU) and mechanical ventilation. HRV was calculated using age-adjusted integer HRV (HRVi). Automated pupillometry and skin temperatures were recorded during the first 72 h of admission. The primary outcomes were: (1) correlation between HRVi and Neurological Pupil index (NPi), and (2) correlation between HRVi and delta skin temperature.</p><p><strong>Results: </strong>Of 29 patients enrolled, 18 had pupillometer data and 20 had temperature data. There were significant, small correlations between left and right NPi values and HRVi (r = 0.13, r = 0.12; p < 0.001), and delta skin temperatures and HRVi (r = 0.15, p < 0.001), which persisted after adjusting for confounders.</p><p><strong>Conclusions: </strong>Abnormal pupillary light response and decreased delta skin temperatures are associated with lower HRVi. If validated, pupillometry and skin temperature could be considered physiologic biomarkers of ANS dysregulation in critically ill children.</p><p><strong>Impact: </strong>While heart rate variability has strong associations with outcomes in critically ill children, there are limited data on other bedside tools of autonomic function in critically ill children. In this study, we found that pupillometry and skin temperature sensors correlate with heart rate variability in critically ill children. These physiological biomarkers may have a role in early detection of autonomic nervous system dysregulation.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365621","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":"Physiological and lifestyle determinants of bone mass in minority children/adolescents from the MetA-Bone Trial.","authors":"Maria Angelica Trak-Fellermeier, Rodolfo Galvan, Jacqueline Hernandez, Preciosa Martinez-Motta, Alisson Macchi, Yolangel Hernandez, Rebeca Martinez, Stephanie Garcia, Zoran Bursac, Cristina Palacios","doi":"10.1038/s41390-025-03921-5","DOIUrl":"https://doi.org/10.1038/s41390-025-03921-5","url":null,"abstract":"<p><strong>Background: </strong>Adolescence leads to enormous skeletal growth. Therefore, understanding predictors of bone mass in this period is paramount to prevent future fractures/osteoporosis.</p><p><strong>Methods: </strong>This was a cross-sectional secondary analysis of the baseline visit of children/adolescents from the MetA-Bone Trial to evaluate the physiological (age, maturity stage, body composition) and lifestyle (diet, physical activity, stress, and sleep) determinants of whole-body and lumbar spine bone mineral content (BMC) and density (BMD).</p><p><strong>Results: </strong>In this sample of 213 predominantly Hispanic boys and girls, we found sex similarities and differences in the predictors of bone mass. Lean mass was a significant positive predictor across all bone outcomes in both boys and girls. In boys, BMI percentile was a negative predictor of lumbar spine BMC (B = -0.035, p = 0.030) while sleep duration was a significant positive predictor of whole-body BMC (B = 8.7, p = 0.036). In girls, physical activity was a significant positive predictor of whole-body BMD (B = 2950-E-5, p = 0.029). The other variables studied were not significant predictors of bone mass in this sample.</p><p><strong>Conclusion: </strong>There were important determinants of bone mass in this sample, but longitudinal studies are needed to understand their role in bone mass acquisition during puberty.</p><p><strong>Impact: </strong>Physiological and lifestyle determinants of bone mass in this sample of predominately Hispanic children and adolescents were mainly lean mass. Self-reported race, ethnicity, family history of osteoporosis, diet quality (HEI-2020), and stress did not significantly predict bone mass in this sample. Identifying physiological and novel modifiable lifestyle factors to maximize bone mass acquisition in Hispanic children and adolescents is paramount to designing targeted interventions to promote long-term bone health and quality of life.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365626","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":"Detection of pulmonary hypertension in preterm infants with bronchopulmonary dysplasia using oxygen saturation data.","authors":"Pravitha Ramanand, Premananda Indic, Samuel J Gentle, Namasivayam Ambalavanan","doi":"10.1038/s41390-025-03891-8","DOIUrl":"https://doi.org/10.1038/s41390-025-03891-8","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) complicates the clinical course of bronchopulmonary dysplasia (BPD) in preterm infants, increasing risk of mortality and other morbidities. Early detection of PH may provide the clinical opportunity for earlier initiation of PH targeted therapies.</p><p><strong>Methods: </strong>We analyzed variability patterns of oxygen saturation data in 41 preterm infants with BPD and associated PH and 57 infants with BPD alone using irregularity indices to identify PH. Irregularity of oxygen saturation (SpO₂) variability time series was characterized by sample entropy over multiple time scales, and characteristic features were derived. Multivariable logistic regression models with entropy-based indices and significant clinical risk factors as features were developed and their diagnostic accuracy metrics were evaluated.</p><p><strong>Results: </strong>SpO₂ measures significantly differed between groups by PH status. The model with signal-based measures and clinical features of birthweight, sepsis, and presence of patent ductus arteriosus had discriminative ability for PH with 82% area under ROC (95% CI: 75%, 88%) and accuracy, sensitivity, and specificity of 81%, 78% and 82% respectively.</p><p><strong>Conclusion: </strong>Irregularity profiles of oxygen saturation variability are distinct in infants with BPD and PH. Signal based measures derived from routinely collected SpO₂ data can be leveraged as continuous bedside markers to detect PH in preterm infants.</p><p><strong>Impact: </strong>Early detection of pulmonary hypertension (PH) may improve outcomes in infants with bronchopulmonary dysplasia (BPD). Bedside markers which can track evolving PH, using routinely collected data in the NICU are hence important. Analysis of the irregularity exhibited by oxygen saturation variability data from preterm infants with BPD identified distinctive behavior in the presence of PH. We demonstrated detection of PH using signal measures accounting for known clinical risk factors using data acquired prior to clinical diagnosis. This study expands the possibility of implementing signal based models for early identification of PH in this vulnerable population.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365625","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":"Confirmation of successful supraglottic airway device placement in neonates using a respiratory function monitor.","authors":"Robyn Dvorsky, Tobias Werther, Katharina Bibl, Michael Schneider, Christoph Binder, Lisa Habrina, Katrin Klebermaß-Schrehof, Veronika Kranebitter, Georg M Schmölzer, Angelika Berger, Michael Wagner","doi":"10.1038/s41390-025-03810-x","DOIUrl":"https://doi.org/10.1038/s41390-025-03810-x","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the use of a respiratory function monitor (RFM) to guide the placement of a supraglottic airway device (SAD) in neonates during intensive care interventions. We hypothesized that using a RFM would decrease the number of attempts needed for a successful placement.</p><p><strong>Methods: </strong>This single-center pilot study was carried out at a tertiary NICU at the Medical University of Vienna. Patients were ventilated using a SAD during neurosurgical or endoscopic interventions. A RFM was either hidden (but recording) or visible to providers during SAD placement. Feedback from the RFM was used to assess correct/incorrect placement and optimize ventilation quality. The parameter leakage was used for assessment: if leak was <30%, correct placement was assumed. The primary outcome was the number of attempts until correct placement. Secondary outcomes included ventilation parameters recorded by the RFM and the duration of SAD placement.</p><p><strong>Results: </strong>Six patients were included in this pilot trial. Using a RFM to guide SAD placement led to fewer attempts (median attempts: 3 [hidden] vs. 1 [visible]). Furthermore, using the RFM, necessary adaptations were made to the SAD position to decrease leakage (mean leakage: 74.8% [hidden] vs. 17.8% [visible]), subsequently endoscopy after insertion of SAD using the RFM then confirmed anatomically correct position.</p><p><strong>Conclusion: </strong>This pilot study indicated that a RFM might be useful to provide guidance during SAD placement.</p><p><strong>Impact statement: </strong>Feedback from a RFM reliably indicated correct anatomical placement of a SAD by correlating low leakage values with proper SAD positioning. RFM guidance could improve neonatal airway management, reducing procedural time and number of attempts. We present promising preliminary results. Further research is needed to confirm these findings.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256278","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":"Pediatric research with impact: connecting families to developmental resources.","authors":"Manuela Iglesias, Daniella S McCausland, Lora Jackle, Megan Tierney, Jessica Harkness, Robin Baker, Gianluca Ursini, Sarah B Mulkey","doi":"10.1038/s41390-025-03902-8","DOIUrl":"https://doi.org/10.1038/s41390-025-03902-8","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256281","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 developmental role for toll like receptor 4 in the neonatal intestine.","authors":"David J Hackam","doi":"10.1038/s41390-025-03900-w","DOIUrl":"https://doi.org/10.1038/s41390-025-03900-w","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256275","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":"Urbanisation and mental health in left-behind children: systematic review and meta-analysis using resilience framework.","authors":"Kelly Lin, Leona Mak, Jinxuan Cai, Stephen Jiang, Nawaal Fayyaz, Simon Broadley, Jing Sun","doi":"10.1038/s41390-025-03894-5","DOIUrl":"https://doi.org/10.1038/s41390-025-03894-5","url":null,"abstract":"<p><strong>Background: </strong>Prolonged parental separation at young ages has significant adverse effects on development in left-behind-children (LBC). We aimed to compare mental health status, emotional and behavioural problems, and their association with socioemotional development between LBC and their counterparts.</p><p><strong>Methods: </strong>Cross-sectional studies comparing LBC and non-LBC published from 2000 onwards were searched. Primary outcomes included depression, anxiety emotional and behavioural problems. Secondary outcomes included loneliness, self-harm, suicide, and risk-related behaviours. Quality of all included articles was assessed by Joanna Briggs Institute (JBI) critical appraisal. Data was analyzed by random model-based effect method.</p><p><strong>Results: </strong>78 observational studies comprising of 394,308 children aged 2-18 were included. Compared to NLBC, LBC had significantly more depression, anxiety, emotional and behavioural problems, conduct problems, self-harm, loneliness, peer bullying, attempts of smoking and alcohol consumption. Subgroup analyses found that younger LBC between the ages of 6 to 12 were at greater risks of poor mental health, emotional and behavioural problems.</p><p><strong>Conclusion: </strong>Absent parental care prevents healthy socio-emotional development and hinder the formation of secure attachment. Poor social-emotional development leads to worse emotional resilience against psychological stressors, while LBC residing in rural areas also experience additional risk factors of low household income and poor access to mental health services.</p><p><strong>Impact statement: </strong>Prolonged parental separation negatively influences mental health, especially in younger children between the ages 6 to 12. Poor social-emotional development in left-behind children is associated with worse emotional resilience against psychological stressors. Additional risk factors including residing in rural areas, low household income, and poor access to mental health services predisposes left-behind children to high risks of mental illness. Timely support services targeted towards strengthening resilience factor such as learning better emotional and behavioural coping strategies and improving school and peer support to address increased risk of mental health problems are required for current left-behind children.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256284","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":"Editor’s Focus","authors":"","doi":"10.1038/s41390-024-03797-x","DOIUrl":"10.1038/s41390-024-03797-x","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":"97 1","pages":"1-1"},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256287","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":"Brain MRI T2 hyperintensity and neurodevelopmental outcomes in neonatal encephalopathy.","authors":"Rhandi Christensen, Elysa Widjaja, Daphne Kamino, Eva Mamak, Linh G Ly, Emily W Y Tam","doi":"10.1038/s41390-025-03907-3","DOIUrl":"https://doi.org/10.1038/s41390-025-03907-3","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to examine the association between early brain MRI T2 hyperintensity and neurodevelopmental outcomes in term infants with neonatal encephalopathy.</p><p><strong>Methods: </strong>A prospective cohort of neonates born ≥ 36 weeks postmenstrual age with neonatal encephalopathy underwent brain MRI in the early postnatal period. Scans were graded for T2 hyperintensity using Kidokoro scoring, and diffusion restriction using Barkovich scoring. The association between T2 hyperintensity (diffuse, mamillary body, pons) and Bayley-III cognitive, language, and motor composite scores at 3 years was examined using multivariable linear regression modeling.</p><p><strong>Results: </strong>The cohort included 102 term infants (63% males), with brain MRI at a median of 4 days of age (IQR: 1). T2 hyperintensity was present in 76% diffusely, 28% in the mamillary bodies, and 17% in the pons. Diffuse T2 hyperintensity score and mamillary body T2 hyperintensity were not associated with cognitive, language, and motor outcomes at 3 years of age when controlling for diffusion restriction.</p><p><strong>Conclusions: </strong>T2 hyperintensity is a common neuroimaging finding on early brain MRI in neonatal encephalopathy. Diffuse, mamillary body, and pontine T2 hyperintensity were not associated with early neurodevelopmental outcomes and can help guide neuroprognostication in this population.</p><p><strong>Impact statement: </strong>T2 hyperintensity on early brain MRI is a common finding in neonatal encephalopathy, however, it is not associated with neurodevelopmental outcomes at 3 years. These results can help with neuroprognostication in the neonatal intensive care unit. T2 hyperintensity in neonatal encephalopathy on early brain MRI is unlikely to influence future cognitive, language, and motor outcomes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189944","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":"Experimental validation of a novel portable device integrating an oxygen concentrator and a ventilation module for patients with ALI/ARDS in low resource countries: a cross-over non-inferiority trial.","authors":"Sofia Poletto, John Diaper, Aurora Montanarini, Giovanni Merighi, Fabienne Fontao, Xavier Belin, Emanuela Zannin, Walid Habre, Raffaele L Dellacà","doi":"10.1038/s41390-024-03792-2","DOIUrl":"10.1038/s41390-024-03792-2","url":null,"abstract":"<p><strong>Background: </strong>This non-inferiority, cross-over study aims to evaluate a novel proof-of-concept portable respiratory support device specifically designed for low-resource settings. The device integrates a ventilation module and an oxygen concentrator.</p><p><strong>Methods: </strong>We studied twelve 4-week-old piglets with a mean weight of 8.4 kg before and after oleic acid-induced acute respiratory distress syndrome (ARDS). In each condition, animals received 1-h pressure control ventilation using a conventional ventilator (Servo-i, Getinge, SE) and the experimental ventilator in random sequence. Arterial blood gas analysis was performed every half-hour to adjust the ventilator settings. The primary outcome was partial pressure of oxygen to FiO₂ ratio (P/F) with a non-inferiority margin of 50 mmHg.</p><p><strong>Results: </strong>P/F did not differ significantly between the experimental and the control ventilation at baseline (459.6(30.9) vs 454.4(28.6) mmHg) and during ARDS condition (165.1(36.9) vs 182.5(48.4) mmHg). The upper 95% CI of the difference between P/F after ventilation using the control and the experimental ventilator was 37.3 and 44.1 mmHg during baseline and ARDS, respectively.</p><p><strong>Conclusions: </strong>The experimental device was not inferior to a conventional ventilator during both baseline and ARDS conditions, suggesting that it can provide adequate treatment to infants with mild to moderate hypoxemic lung disease in resource-limited care settings.</p><p><strong>Impact statement: </strong>This manuscript provides the results of a non-inferiority study that compared a novel proof-of-concept respiratory support device, integrating a ventilation module and an oxygen concentrator, specifically designed for respiratory support in low-resource settings, with a conventional pediatric intensive care ventilator in an oleic-acid model of acute lung injury. Our results showed that the experimental device was non-inferior to a conventional ventilator, suggesting that it can provide adequate treatment to infants with mild to moderate hypoxemic lung disease in resource-limited care settings. The developed solution can also be relevant for other applications, including home mechanical ventilation.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189946","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}