Pediatric Research最新文献

{"title":"Beyond ECMO: rethinking drivers of long-term outcomes in critically ill children.","authors":"Joshua Feder, Pramod S Puligandla","doi":"10.1038/s41390-026-05582-4","DOIUrl":"https://doi.org/10.1038/s41390-026-05582-4","url":null,"abstract":"<p><p>Pediatric extracorporeal membrane oxygenation (ECMO) saves lives, but its long-term neurodevelopmental cost has been difficult to isolate from the burden of critical illness itself. Le Helleye and colleagues address this with a prospective, matched case-control study comparing ECMO survivors to general PICU survivors matched for age, diagnosis, and admission year. Overall health-related quality of life (HRQoL) was modestly lower in ECMO survivors. Physical functioning, however, showed a clear and robust deficit, persisting even against critically ill comparators. Psychosocial functioning did not differ significantly between groups, suggesting this domain is driven more by contextual and family factors than ECMO-specific injury. Roughly one-third of the entire cohort-ECMO and non-ECMO alike-showed clinically significant executive dysfunction, which proved the strongest independent predictor of poor HRQoL across all domains, outweighing ECMO's own effect. Parental stress emerged as a comparably powerful, and modifiable, mediator of child outcomes. Together these findings argue for reframing post-PICU follow-up: neurodevelopmental monitoring and structured family psychological support as core components of critical care recovery.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113364","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":"Heart rate variability after hospital discharge in perinatal risk populations: a systematic review and meta-analysis.","authors":"Lisa Gistelinck, Rowena Van den Broeck, Cato Verhelst, Maarten De Vos, Sam Wass, Gunnar Naulaers, Bart Boets","doi":"10.1038/s41390-026-05416-3","DOIUrl":"https://doi.org/10.1038/s41390-026-05416-3","url":null,"abstract":"<p><strong>Background: </strong>Perinatal risk factors such as preterm birth, intrauterine growth restriction, and low birth weight are linked to elevated cardiovascular and neurodevelopmental risk. Heart rate variability (HRV) is widely used to assess autonomic function in these populations, yet findings remain inconsistent. While autonomic differences during the NICU period are well established, less is known about HRV after hospital discharge across childhood and adulthood.</p><p><strong>Methods: </strong>PubMed, EMBASE, Web of Science, Scopus, and APA PsycArticles were searched through April 2025, supplemented by ClinicalTrials.gov and reference screening. Peer-reviewed studies comparing HRV between perinatal risk populations and healthy full-term controls after hospital discharge were eligible. We extracted 156 effect sizes from 27 studies.</p><p><strong>Results: </strong>Overall effects were modest and highly heterogeneous (d = -0.21, p = 0.14; I² =  89.3%). Growth-related conditions (small-for-gestational-age, intrauterine growth restriction) showed the most consistent HRV reductions. Preterm birth and low birth weight showed no significant overall effects but substantial between-study heterogeneity across age groups. Younger samples showed larger group differences than older samples.</p><p><strong>Conclusion: </strong>Autonomic associations with perinatal risk factors appear condition-specific and age-dependent, although the predominantly cross-sectional design precludes conclusions about within-individual change. Findings underscore the importance of age- and condition-specific assessment and the need for longitudinal follow-up.</p><p><strong>Impact: </strong>HRV associations with perinatal risk factors are condition-specific and vary across age. Effect sizes were most consistent for growth-related conditions (small-for-gestational-age and intrauterine growth restriction), pronounced in preterm-born infants but smaller and more variable in older groups, and small or non-significant for low and extremely low birth weight samples. This is the first meta-analysis to quantify HRV differences across perinatal risk populations from infancy to adulthood, focusing on the post-discharge period and showing that timing and etiology, rather than parameter choice, drive inconsistencies. The findings guide condition-specific assessment and underscore the need for longitudinal studies separating catch-up from survivor bias.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113379","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":"Editing the rulebook: building the policy environment for children to access gene therapy.","authors":"Christian D Pulcini, Kao-Ping Chua, Rena M Conti","doi":"10.1038/s41390-026-05588-y","DOIUrl":"https://doi.org/10.1038/s41390-026-05588-y","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113315","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":"Global, regional, national trends and economic evaluation of neonatal hyperbilirubinemia burden, 2003-2023.","authors":"Ramesh Vidavalur","doi":"10.1038/s41390-026-05541-z","DOIUrl":"https://doi.org/10.1038/s41390-026-05541-z","url":null,"abstract":"<p><p>Severe neonatal hyperbilirubinemia remains a preventable cause of neonatal death and lifelong neurologic disability, yet contemporary global estimates are limited. Using Global Burden of Disease 2023 data for 204 countries, we analyzed incidence, deaths, and disability-adjusted life-years (DALYs) from extreme hyperbilirubinemia (EHB) among neonates from 2003 to 2023, applying joinpoint regression, income-stratified k-means clustering and correlation analysis, and value-per-statistical-life (VSL) and human-capital economic valuation. Globally, incident cases fell 29% (542,966-387,366) and deaths fell 66% (70,907-24,050); the mortality-to-incidence ratio halved from 13.1% to 6.2%. The average annual percent change was -1.5% for incidence and -5.0% for mortality. The Middle East and North Africa had the largest declines in cases (61%) and deaths (72%). In 2023, South Asia and Sub-Saharan Africa accounted for 68% of incident cases and 90% of deaths, lower-middle-income countries for roughly two-thirds of deaths and DALYs, and India, Pakistan, and Nigeria for about half of global mortality. Incidence and mortality were strongly correlated in low-income countries (r = 0.72) but decoupled in upper-middle-income countries (r = 0.19; P = 0.167). The 2023 burden represented $6.9-10.4 billion in VSL-based welfare losses and $13.0 billion in DALY-based human-capital losses. Progress is substantial but uneven across World Bank regions and income groups. IMPACT: Severe neonatal hyperbilirubinemia and kernicterus remain important causes of preventable neonatal death and lifelong neurologic disability. Contemporary evidence is limited on how the burden has changed across regions and income groups and whether neonatal jaundice incidence remains closely associated with mortality. Between 2003 and 2023, modeled incident cases decreased by 29%, while deaths declined by 66%. The burden was mostly concentrated in South Asia, Sub-Saharan Africa, and lower-middle-income countries. Incidence was strongly associated with mortality in low-income settings but largely decoupled from mortality in upper-middle-income settings. Future studies should link burden estimates with screening coverage, bilirubin measurement, phototherapy quality, referral capacity and long-term neurodevelopmental outcomes to identify modifiable health-system factors and guide context-specific interventions.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113392","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/s41390-026-05420-7","DOIUrl":"10.1038/s41390-026-05420-7","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":"100 2","pages":"511-511"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149100824","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":"Claudin-3 as a marker of intestinal permeability and its relation to inflammatory status in adolescents with functional gastrointestinal disorders.","authors":"Azza Abd El-Shaheed, Nermine N Mahfouz, Heba H Metwaly, Hiba Sibaii, Safa N Abd El-Fattah","doi":"10.1038/s41390-026-05497-0","DOIUrl":"https://doi.org/10.1038/s41390-026-05497-0","url":null,"abstract":"<p><strong>Background: </strong>Functional Gastrointestinal disorders (FGIDs) are highly prevalent among adolescents. Increased intestinal permeability plays a potential role in the pathogenesis of FGIDs. Claudin-3 (CLDN3) may serve as an indicator of gut barrier integrity. We aimed to assess serum level of CLDN3 as a noninvasive biomarker of intestinal permeability in adolescents with FGIDs, and its relation with inflammatory markers.</p><p><strong>Methods: </strong>This study included 70 adolescents with FGIDs and 65 healthy controls. Serum levels of CLDN3 and inflammatory markers; C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα), and haptoglobin, were measured using enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Serum levels of CLDN3 and inflammatory markers; CRP, Il-6, TNFα and haptoglobin, were significantly higher in cases compared to controls (p = 0.02, 0.039, 0.04, 0.021 and 0.001, respectively). We detected significant positive correlations between serum level of CLDN3 and that of CRP, IL-6 and haptoglobin in cases.</p><p><strong>Conclusion: </strong>Our results revealed significant elevations in serum levels of CLDN3 and inflammatory markers in adolescents with FGIDs. Significant positive correlations were detected between levels of CLDN3 and that of CRP, IL-6 and haptoglobin, suggesting an association between intestinal barrier dysfunction and low-grade systemic inflammation. Thus, CLDN3 represents a potential noninvasive biomarker of intestinal permeability in FGIDs.</p><p><strong>Impact: </strong>This research investigated the potential role of Claudin-3 (CLDN3) as a noninvasive biomarker of intestinal permeability in adolescents with Functional Gastrointestinal Disorders (FGIDs), and its relation to the inflammatory status of these patients. To the best of our knowledge, this is the first study to assess serum CLDN3 as a noninvasive biomarker of intestinal permeability in FGIDs; previous researches have assessed intestinal barrier disruption in FGIDs based on intestinal biopsies. Our findings suggest that impaired intestinal barrier function may promote development of FGIDs by inducing inflammation. Thus, restoration of intestinal barrier integrity may represent a potential therapeutic target for FGIDs.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113369","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":"Reactive rather than proactive: nurses' perspectives on decision-making in neonatal vascular access.","authors":"Matheus Fpt van Rens, Anita Huis, Kevin Hugill, Robin van der Lee, Willem P de Boode","doi":"10.1038/s41390-026-05570-8","DOIUrl":"https://doi.org/10.1038/s41390-026-05570-8","url":null,"abstract":"<p><strong>Background: </strong>Neonatal vascular access is essential for life-sustaining therapies but is associated with frequent device failure, repeated procedures, and patient harm. Although technical aspects have been widely studied, less is known about how organisational and behavioural factors influence decision-making.</p><p><strong>Methods: </strong>We conducted a multicentre qualitative study across three tertiary neonatal intensive care units in the Netherlands. Semi-structured interviews were conducted with 12 neonatal nurses involved in vascular access and infusion therapy. Data were analysed using reflexive thematic analysis, with sample adequacy guided by information power.</p><p><strong>Results: </strong>Four themes were identified. Participants described vascular access care as predominantly characterised by reactive decision-making, with escalation commonly occurring after complications rather than through anticipatory planning. Delayed escalation, repeated peripheral intravenous attempts, and inconsistent monitoring were reported across all centres. Participants described organisational pressures, variability in knowledge and implementation, and limited parental involvement as factors influencing these patterns. A persistent gap between risk awareness and clinical action emerged from the interviews.</p><p><strong>Conclusion: </strong>Participants suggest that vascular access care is influenced by interacting organisational, behavioural, knowledge-related, and relational factors that may reinforce reactive practice. Promoting anticipatory vascular access care through structured, workflow-integrated approaches may improve consistency, reduce avoidable harm, and support safer vascular access care.</p><p><strong>Impact: </strong>Identifies a predominantly reactive pattern of vascular access care within neonatal nurses' accounts across three tertiary NICUs. Identifies organisational, behavioural, knowledge-related, and relational factors that may contribute to delayed escalation beyond technical considerations. Extends existing literature by providing insight into factors that may contribute to repeated peripheral catheter failure and delayed escalation in routine practice. Supports consideration of structured, anticipatory vascular access approaches integrated into clinical workflows to reduce avoidable harm and improve patient safety.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113348","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":"Process mapping: finding new routes to guideline adherence.","authors":"Spyridon Karageorgos, Damian Roland","doi":"10.1038/s41390-026-05550-y","DOIUrl":"https://doi.org/10.1038/s41390-026-05550-y","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113326","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 journey to establishing systems of care for all children, starting at birth: the Society for Pediatric Research's 2026 Mary Ellen Avery award.","authors":"Wendy K Chung","doi":"10.1038/s41390-026-05580-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05580-6","url":null,"abstract":"<p><p>Careers in medicine for physician scientists may have a long gestational period, but the birth of innovation can bring significant improvements in the care of patients. Mary Ellen Avery exemplified such a career with a lasting impact.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113404","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":"Fathers, not mothers: the male singing voice and the preterm brain's response to song in the NICU.","authors":"Efthymios Papatzikis, Kyriakos Dimitropoulos, Kassandra Tataropoulou, Elena Pasoudi, Angeliki Nika","doi":"10.1038/s41390-026-05551-x","DOIUrl":"https://doi.org/10.1038/s41390-026-05551-x","url":null,"abstract":"<p><strong>Background: </strong>The preterm infant leaves the womb still building its auditory brain, trading maternal voice and heartbeat for the noise of intensive care. Singing tries to hand some of that back, and is built almost entirely around the mother, without having ever tested this premise against the father or any other caregiver.</p><p><strong>Methods: </strong>In a registered trial (NCT06398912) we recorded EEG in preterm infants, each hearing the same stimuli-block from four facilitators (mother, father, female, and male music therapist) crossing kinship with F0/pitch. Delta-band power was the pre-registered primary outcome; the hypothesis was maternal dominance.</p><p><strong>Results: </strong>Hypothesis was not supported. The mother's apparent lead vanished once each session was referenced to its own baseline (silence), while results ran the other way: during the lullaby, the most complex stimulus, and the one the fixed order placed last against waning engagement, the father's voice drew the highest Delta power, and the two male voices together outdrew the female. Results held under bootstrap.</p><p><strong>Conclusion: </strong>The preterm cortex followed the male (father's foremost) low, spectrally full voice, providing a robust signal, pointing somewhere concrete: fathers, among the most sidelined figures in the NICU, may hold a defined, testable role in their own infant's care.</p><p><strong>Impact: </strong>The trial's registered prediction-that the maternal voice would most strongly engage the preterm brain-was not supported; during a sung lullaby, male voices, the father's foremost, evoked the largest short-term response. To our knowledge, this is the first full cohort qEEG evidence that a singer's biological sex, rather than maternal kinship, tracks the preterm cortical response to song. If replicated, the result argues for deliberately including fathers and male voices in NICU music and family-centered care, which remain built largely around the mother.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113356","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}