Pediatric Research最新文献

{"title":"Temporal trends of avoidable mortality among children under-five in China from 2004 to 2021.","authors":"You-Xiang Wang, Yao-Dong Zhang, Yi-Ran Wang, Yu-Wei Hou, Kai-Juan Wang","doi":"10.1038/s41390-025-03979-1","DOIUrl":"10.1038/s41390-025-03979-1","url":null,"abstract":"<p><strong>Background: </strong>Avoidable mortality (AM) refers to deaths preventable through effective prevention measures or timely medical treatment, and reducing AM is crucial for improving child survival rates. We conducted an analysis of the situation and temporal trends of AM among under-five (U5) children in China.</p><p><strong>Methods: </strong>Data were extracted from the China Death Surveillance Dataset. The Joinpoint regression and multivariate linear regression were used.</p><p><strong>Results: </strong>The AM rate among U5 children decreased from 233.99/100,000 in 2004 to 34.54/100,000 in 2021, with an average annual percentage change of -10.72% (-11.90%, -9.98%). The proportion of AM generally showed a downward trend, with urban-rural disparities observed particularly evident by year-end 2021. Perinatal mortality is declining at an average rate of 9.75% per year, the proportion of perinatal deaths to all deaths has not changed significantly, and even the proportion of deaths caused by birth injury and suffocation has increased (annual percent change: 0.95%, 95% CI:0.39% to 1.59%). For boys and girls aged 1-5 years, the leading causes of death are drowning and land transport accidents, respectively, with the incidence of drowning in rural areas being higher than in urban areas.</p><p><strong>Conclusions: </strong>China has reduced AM in U5 children, but rural areas still need targeted interventions to address preventable deaths and achieve Sustainable Development Goals.</p><p><strong>Impact: </strong>Avoidable mortality among children under-five in China decreased by an average of 10.72% between 2004 and 2021, with urban-rural differences. Perinatal mortality declined by 9.75% annually, but the proportion of perinatal deaths remained stable, while deaths from birth injury and suffocation increased. For boys aged 1-5 years, drowning is the leading avoidable cause of death, while for girls, it is land transport accidents, with drowning more prevalent in rural areas. Increasing health technicians in rural areas may narrow the rural-urban gap, with targeted interventions needed for birth injury and suffocation, drowning, and land transport accidents.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586567","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":"Long-term follow-up strategies for children after severe acute kidney injury.","authors":"Giovanni Ceschia, Donna J Claes, Kelli A Krallman, Michaela Collins, Stuart L Goldstein","doi":"10.1038/s41390-025-03965-7","DOIUrl":"https://doi.org/10.1038/s41390-025-03965-7","url":null,"abstract":"<p><strong>Background: </strong>Children experiencing acute kidney injury (AKI) are at heightened risk of developing chronic kidney disease (CKD). While identifying patients at high-risk for CKD after AKI early is crucial, indefinite follow-up may strain healthcare resources. We assessed potential predictive factors for CKD following AKI to guide safe discontinuation of follow-up after one year.</p><p><strong>Methods: </strong>We evaluated outcomes of children with AKI prospectively. We assessed for associations between hospitalization and first-year outpatient data with presence of estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m² or CKD (eGFR <60 or 60-90 with proteinuria) at 3-5 years after AKI.</p><p><strong>Results: </strong>96 patients were included. Patients with eGFR <90 had longer AKI duration, higher prevalence of AKI stage 3, and received more KRT. No patient with CKD at 3-5 years was CKD-free in the first year of follow-up and only three patients with normal eGFR during the first year post-AKI had abnormal eGFR at 3-5 years; all had complex medical diseases which would necessitate kidney function monitoring as standard of care.</p><p><strong>Conclusions: </strong>Our data suggest patients without eGFR<90/CKD during the first year post-AKI have low CKD risk in the following 2-4 years and may be safely discharged from nephrology clinics after one year of follow-up.</p><p><strong>Impact: </strong>Patients without eGFR <90/CKD during the first year post-AKI have low CKD risk in the following 2-4 years. Lack of CKD in the first year post-AKI is maintained up to 3-5 years after the original episode. Patients without eGFR <90/CKD in the first year post-AKI can be safely discharged from nephrology care.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586513","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":"Avocado consumption during pregnancy linked to lower child food allergy risk: prospective KuBiCo study.","authors":"Feon W Cheng, Ella Bauer, Nikki A Ford, Katri Backman, Raimo Voutilainen, Markku Pasanen, Leea Keski-Nisula, Sari Hantunen","doi":"10.1038/s41390-025-03968-4","DOIUrl":"https://doi.org/10.1038/s41390-025-03968-4","url":null,"abstract":"<p><strong>Background: </strong>Maternal exposures during pregnancy play a critical role in offspring's health outcomes. This study aimed to investigate how maternal avocado consumption during pregnancy relates to offspring allergic health outcomes using the Kuopio Birth Cohort (KuBiCo) Study.</p><p><strong>Methods: </strong>This prospective cohort study used data from KuBiCo. Avocado consumption was assessed using an online food frequency questionnaire in trimesters (T) 1 and 3. Avocado consumers were defined as participants who reported consuming any avocado (>0 grams) in T1 and/or 3, and avocado non-consumers were defined as those who didn't report consuming any avocado (0 grams) in both T1 and 3. The 12-month follow-up questionnaire captured offspring allergic outcomes (rhinitis, paroxysmal wheezing, atopic eczema, and food allergy).</p><p><strong>Results: </strong>Of 4647 participants, 2272 met the criteria and were included in the analysis. Compared to avocado non-consumers (during pregnancy), avocado consumers (during pregnancy) had 43.6% lower odds of reporting food allergy among their children at the 12-month follow-up questionnaire while adjusted for relevant covariates. No significant associations were noted in the other three allergic health outcomes in the fully adjusted model.</p><p><strong>Conclusion: </strong>Avocado consumption during pregnancy was associated with lower odds of infant food allergies at 12 months, even when accounting for potential covariates.</p><p><strong>Impact: </strong>Maternal exposures, such as nutrition during pregnancy, can affect offspring health outcomes. Consuming certain nutrients, which are found in avocados, during pregnancy have been associated with lower allergic health outcomes in children. Avocado consumption during pregnancy is found to be associated with lower odds of infant food allergies at 12 months, even when accounting for potential covariates.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586536","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":"Causal link between type 1 diabetes mellitus and juvenile idiopathic arthritis in Europe.","authors":"Meng-Na Lv, Peng-Cheng Liu, Jian-Bin Li, Yi-Lin Peng, Shu-Jiao Yu, Rui Wu","doi":"10.1038/s41390-025-03975-5","DOIUrl":"https://doi.org/10.1038/s41390-025-03975-5","url":null,"abstract":"<p><strong>Background: </strong>Several observational studies have shown an association between the presence of type 1 diabetes mellitus (T1DM) and the risk of developing juvenile idiopathic arthritis (JIA). The occurrence of comorbidities is a painful for children and their families. Therefore, a bidirectional Mendelian randomization (MR) study was conducted.</p><p><strong>Methods: </strong>The inverse-variance weighting (IVW), weighted median, MR-Egger and MR-cML methods were used for evaluation. Furthermore, several sensitivity analyses were applied to assess the robustness of the results. LD Score Regression (LDSC) was used as a supplement to MR analysis. After accounting for confounders, The multivariable MR (MVMR) analysis and MVMR-cML methods were conducted to verify the direct effect.</p><p><strong>Results: </strong>The MR IVW and MR-cML methods revealed a causal association between T1DM status and the risk of developing JIA. However, there was no evidence of a causal relationship between T1DM status and the risk of developing JIAU. The sensitivity analysis suggested that the results were credible. LDSC verified the reliability of MR analysis. MVMR and MVMR-cML methods indicated that the association between T1DM and JIA was independent of confounders.</p><p><strong>Conclusion: </strong>MR analysis supports a causal association between T1DM status and the risk of developing JIA.</p><p><strong>Impact: </strong>This study uses bidirectional, LD Score Regression and multivariable Mendelian Randomization to establish a causal link between type 1 diabetes mellitus (T1DM) and juvenile idiopathic arthritis (JIA) in children. Our study addresses gaps in existing research and provides a possible causal relationship between the two diseases for the first time. This analysis provides clinicians with a basis for disease prevention, and effectively reduces the distress caused by comorbidities to children and families. At the same time, it provides some ideas for the study of the related mechanism of T1DM and JIA in children.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586559","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":"Routinely collected physiological data improves the assessment of acute brain injury severity.","authors":"Nathan Stevenson, Michaela Waak, Karen M Barlow","doi":"10.1038/s41390-025-03969-3","DOIUrl":"https://doi.org/10.1038/s41390-025-03969-3","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573607","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":"Positive impact of sodium L-lactate supplementation on blood acid-base status in preterm newborns.","authors":"Ifrah Omar Ibrahim, Chloé Perrot, Hélène Roumes, Marie-Christine Beauvieux, Olivier Brissaud, Sophie Cramaregeas, Eric Dumas-de-la-Roque, Luc Pellerin, Jean-François Chateil, Olivier Tandonnet, Anne-Karine Bouzier-Sore","doi":"10.1038/s41390-025-03963-9","DOIUrl":"https://doi.org/10.1038/s41390-025-03963-9","url":null,"abstract":"<p><strong>Background: </strong>Preclinical studies indicate that lactate is a crucial cerebral energy substrate, with Na-L-lactate administration significantly reducing brain lesion volumes and improving motor and cognitive functions following neonatal hypoxia-ischemia in rat pups. Its neuroprotective effects are linked to neuronal metabolic utilization, making it a promising candidate for treating newborns with hypoxia-ischemia encephalopathy, a condition where hypothermia remains the only established therapy. However, before initiating a clinical trial, it is necessary to assess the effects of Na-L-lactate infusion on blood parameters.</p><p><strong>Methods: </strong>We retrospectively analyzed blood parameters in 60 premature neonates during their first days of life. Among them, 30 received Na-L-lactate instead of Na-Cl to prevent hyperchloremic acidosis. Blood pH, lactatemia, bicarbonates, glycemia, natremia, chloremia, base excess, and hemoglobin were monitored before, during, and after Na-L-lactate infusion.</p><p><strong>Results: </strong>Our findings showed that Na-L-lactate infusion lowered blood lactate levels while increasing pH from 7.25 to 7.31. After stopping the infusion, lactatemia was 1.9 mM, and pH reached 7.32. Na-L-lactate supplementation effectively restored normal blood pH, maintained natremia, and prevented hyperchloremia. Notably, even in cases of high initial lactatemia, lactate levels decreased during the infusion.</p><p><strong>Conclusion: </strong>Our data are promising and emphasize the need for further research to explore its potential applications in neonatal clinical care.</p><p><strong>Impact: </strong>Sodium L-lactate infusion does not increase blood lactate levels and restores normal pH in premature neonates. The study demonstrates that sodium L-lactate infusion avoids hyperchloremia while maintaining sodium levels, offering a potential alternative to sodium chloride. These findings highlight the need for additional research studies to further evaluate the safety, efficacy, and potential applications of sodium L-lactate infusion in neonatal care.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573606","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":"Cytotoxic T-cell activation profile in critically ill children with malignancies and hemophagocytic lymphohistiocytosis.","authors":"Sijuan Sun, Yue Liu, Hui Zhao, Yan Miu, Xiaohang Huang, Shuhong Shen, Hong Ren, Jian Zhang","doi":"10.1038/s41390-025-03962-w","DOIUrl":"https://doi.org/10.1038/s41390-025-03962-w","url":null,"abstract":"<p><strong>Background: </strong>The early identification of hemophagocytic lymphohistiocytosis (HLH) in critically ill children with malignancies is challenging. The value of an activated cytotoxic T-cell profile in diagnosing HLH in this group of patients is unknown.</p><p><strong>Methods: </strong>Critically ill children with malignancies who suffered from persistent cytopenia in the pediatric intensive care unit were included. Children were divided into two groups based on how many clinical HLH diagnostic criteria they fulfilled: M-HLH group, ≥5 criteria; hematologic malignancy (HM) group, ≤4 criteria. Flow cytometry tests were performed within 24 h after the patient's admission.</p><p><strong>Results: </strong>Thirty-seven children who fulfilled the requirements were enrolled. Twenty children were classified into the M-HLH group and 17 into the HM group. The M-HLH group exhibited a higher mortality rate than the HM group. CD38 + HLA-DR + CD8+ T cells% and interferon-gamma (IFN-γ) were elevated in the M-HLH group. The area under the curve values of the two indexes were 0.906 and 0.897 respectively for the identification of M-HLH in the critically ill children, with CD38+/HLA-DR + CD8+ T cells% > 39.66% and IFN-γ > 22.58 exhibiting the best performance.</p><p><strong>Conclusion: </strong>Cytotoxic T-cell activation profile with CD38 + HLA-DR + CD8+ T cells% and IFN-γ is valuable in the early diagnosis of HLH in critically ill children with malignancies.</p><p><strong>Impact: </strong>The early diagnosis of hemophagocytic lymphohistiocytosis in critically ill children with malignancies (M-HLH) remains a major challenge for intensivists. Cytotoxic T-cell activation profile with the frequency of CD38 + HLA-DR+ T cells in CD8+ T cells (CD38 + HLA-DR + CD8+ T cells%) and interferon-gamma (IFN-γ) is valuable in the early identification of pediatric M-HLH. These findings will support the future implementation of T-cell activation markers in the clinical management of children with M-HLH.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567874","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":"Extremely preterm infants with adverse neurological outcome present more frequently impaired right ventricular performance.","authors":"Niki Oikonomopoulou, Maria Jose Rodriguez-Castaño, Araceli Corredera, Cristina Cortés-Ledesma, Eva Vierge, Jose Martinez-Orgado, Luis Arruza","doi":"10.1038/s41390-025-03959-5","DOIUrl":"https://doi.org/10.1038/s41390-025-03959-5","url":null,"abstract":"<p><strong>Background: </strong>The relationship between cardiovascular impairment and adverse outcome is insufficiently studied in preterm populations. Our aim was to analyze and compare cardiac performance during postnatal transition in extremely low gestational age infants (ELGANs) with and without adverse short-term neurological outcome.</p><p><strong>Methods: </strong>Prospective observational cohort study. Continuous multimodal monitoring and targeted neonatal echocardiographic studies were conducted within the first 24 h of life (TNE1) and between 24 and 72 h (TNE2). Adverse outcome was defined as the composite of death, significant interventricular hemorrhage, or white matter injury.</p><p><strong>Results: </strong>Of the 46 patients included, 21(45.7%) presented adverse outcome. There were no differences in left ventricular performance. During TNE1, infants with adverse outcome exhibited lower tricuspid annulus plane systolic excursion (TAPSE) and right ventricular global longitudinal strain (GLS-RV), alongside longer RV isovolumic relaxation time (IVRT) and higher RV Myocardial Performance Index (MPI). RV output positively correlated with peak systolic and mean velocity of the middle cerebral artery. By TNE2, RV performance differences had disappeared.</p><p><strong>Conclusions: </strong>Impaired RV performance during early postnatal period is more frequent in ELGANs with adverse neurological outcome. Cerebral blood flow relies more on RV output. The potential role of early RV dysfunction in brain damage deserves further research.</p><p><strong>Impact: </strong>Extremely preterm infants with adverse short-term neurological outcome present more frequently right ventricular dysfunction during early postnatal period, with a positive correlation between cerebral blood flow velocities and right ventricular output. RV performance may play a critical role in maintaining adequate cerebral blood flow; thus a subtle dysfunction could aggravate brain injury. This is the first study pointing towards a potential association between early RV dysfunction and adverse neurological outcome during neonatal transition in extremely preterm infants. Our study highlights the importance of early cardiac assessment and provides a new perspective for improving neonatal care and outcomes for this vulnerable population.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567875","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":"Integrative multi-omics analysis reveals molecular signatures of central obesity in children.","authors":"Chengzhi Zhao, Xizhou An, Leyuan Xiao, Jingyu Chen, Daochao Huang, Lijing Chen, Shenying Fang, Xiaohua Liang","doi":"10.1038/s41390-025-03958-6","DOIUrl":"10.1038/s41390-025-03958-6","url":null,"abstract":"<p><strong>Background: </strong>Central obesity is associated with an increased risk of hypertension and coronary heart disease. However, its molecular mechanisms have not yet been fully understood. This study aims to investigate lipids and proteins related to childhood central obesity, exploring the molecular mechanisms underlying this condition.</p><p><strong>Methods: </strong>A case-control study was conducted, including a total of 169 children (aged 7-16 years, 53.25% male, and 74 children in the central obesity group). Plasma lipidomics were measured in all 169 children, and plasma proteomics was measured in 112 of these children. The transcriptomics and lipidomics of the mice's liver were measured for normal feed and high-fat feed mice.</p><p><strong>Results: </strong>Forty-six key lipids significantly associated with central obesity were identified, predominantly triglycerides (TAG), with a minority being diacylglycerols (DAG). Additionally, six key proteins, namely PLIN1, PLAT, ADH1A, ADH4, LEP, and INHB, were discovered, which may positively influence the central obesity phenotype by modulating levels of lipids such as TAG, DAG, LDL-C, and HDL-C. These proteins exhibited increased expression in the plasma of children with central obesity. Validation using mouse liver samples showed some overlapping differential lipids between mice and children, albeit minimal overlap in differential genes. This discrepancy may stem from inherent differences between transcriptomics and proteomics, species variations, and differing sampling sites.</p><p><strong>Conclusions: </strong>PLIN1, PLAT, ADH1A, ADH4, LEP, and INHB are potential significant biomarkers for childhood central obesity and may influence the phenotype of childhood central obesity by modulating levels of lipids such as TAG, DAG, LDL-C, and HDL-C.</p><p><strong>Impact: </strong>PLIN1, PLAT, ADH1A, ADH4, LEP, and INHB are potentially significant biomarkers for childhood central obesity and may influence the phenotype of childhood central obesity by modulating levels of lipids such as TAG, DAG, LDL-C, and HDL-C. Research on integrating lipidomics and proteomics to elucidate the mechanisms of obesity, especially childhood central obesity, remains extremely limited. Our study filled this gap. Our findings highlight potential biomarkers and therapeutic targets that could pave the way for new interventions and treatments to prevent central obesity in children and its harm.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567876","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":"Puncture approaches for ultrasound-guided kidney biopsy specimens: a pediatric model study using piglet kidneys.","authors":"Tomohiko Nishino, Sakurako Hirano, Shin Takemura, Shinya Tomori, Sayaka Ono, Kazuhiro Takahashi, Masakazu Mimaki","doi":"10.1038/s41390-025-03956-8","DOIUrl":"https://doi.org/10.1038/s41390-025-03956-8","url":null,"abstract":"<p><strong>Background: </strong>The optimal puncture approach for real-time ultrasound-guided native kidney needle biopsy in children remains undetermined due to insufficient evidence. This study evaluated various puncture approaches for glomeruli count and arterial injury in the small kidneys of piglets.</p><p><strong>Methods: </strong>A total of 144 kidneys sourced from a slaughterhouse were examined. On each kidney, three puncture approaches were performed on the lower pole using a 16-gauge needle: Caudocranial, Craniocaudal, and Vertical. Blinded pediatric nephrologists assessed core length, glomeruli count, and arterial injury.</p><p><strong>Results: </strong>The kidneys had a mean vertical length of 9.31 ± 0.59 cm. Of 432 punctures, no punctures traversed the kidney. The Vertical approach yielded a significantly shorter core length than other methods (P < 0.001), but the glomeruli count was consistent across approaches (P = 0.41). Over 60% of the biopsies resulted in arterial injury, with the Caudocranial approach showing significantly higher injury rates (P < 0.03).</p><p><strong>Conclusions: </strong>This study focused on puncture techniques in a pediatric model, suggesting that the Craniocaudal and Vertical approaches are advantageous for selective glomerular sampling without increasing the arterial injury risk. Although further research on smaller kidneys is necessary, these findings offer valuable guidance for biopsy approaches to small kidneys, particularly in pediatric patients.</p><p><strong>Impact: </strong>Kidney biopsy is essential for establishing diagnosis and determining treatment strategies; however, there is no consensus on the puncture approach in children who have the additional risk factor of small-sized kidneys. This study compared between biopsy specimens from piglet models of pediatric kidneys to clarify the best puncture approach based on pediatric characteristics. Although the same number of glomeruli were sampled using all approaches, the Caudocranial approach exhibited a significantly higher incidence of arterial injury. In kidney biopsy that considers the characteristics of children with small kidneys, the Craniocaudal or Vertical approaches may improve the safety and quality of biopsy specimens.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557543","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}