Pediatric Research最新文献

{"title":"Longitudinal changes in cardiopulmonary outcomes of adults born extremely prematurely: United Kingdom Oscillation Study.","authors":"Allan Jenkinson, Christopher Harris, Mona Bafadhel, Reza Razavi, Theodore Dassios, Anne Greenough","doi":"10.1038/s41390-025-04190-y","DOIUrl":"https://doi.org/10.1038/s41390-025-04190-y","url":null,"abstract":"<p><strong>Background: </strong>During puberty, lung function of individuals born extremely prematurely can deteriorate putting them at risk of early chronic obstructive pulmonary disease (COPD). We hypothesise that young adults exposed to postnatal corticosteroids will have poorer lung and cardiac function, higher pulmonary artery pressures and poorer exercise tolerance compared to preterm born adults not exposed to postnatal steroids and term born adults. We further hypothesise lung function differences may be demonstrated depending on mode of ventilation at birth (high frequency oscillatory or conventional ventilation) in preterm born adults.</p><p><strong>Methods: </strong>A prospective study of participants (aged 24-28) from the United Kingdom Oscillation Study (UKOS) and term born controls. Assessments will involve comprehensive lung function, cardiac ultrasound, exercise assessments, inflammatory cell and biomarker profiling and airway microbiome assessment. The primary outcome is the ratio of forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC); to detect a significant difference we will recruit 150 individuals. Statistical analysis will involve mixed effect models with adjustment for imbalances and sensitivity analysis.</p><p><strong>Discussion: </strong>The results may identify adults born extremely preterm at increased risk of COPD and pulmonary hypertension (PH) who might benefit from interventions to delay the onset of COPD and cardiovascular complications such as PH.</p><p><strong>Impact: </strong>Adults born extremely prematurely in the modern era of neonatal care are an emerging population whose long-term outcomes have infrequently been reported. This study will describe their cardiac and lung function, pulmonary artery pressures, exercise capacity and immunobiological profile. We aim to identify risk factors for worse outcomes such as early chronic obstructive pulmonary disease onset and pulmonary hypertension. The results will identify those who might benefit from multi-disciplinary follow-up to ensure interventions are employed to delay the onset of COPD and manage longer term cardiovascular problems.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310278","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":"Combining corticosteroid therapies during preterm ventilation: balancing pulmonary benefits and neuroinflammatory risks.","authors":"Abdul Razak, Atul Malhotra","doi":"10.1038/s41390-025-04239-y","DOIUrl":"https://doi.org/10.1038/s41390-025-04239-y","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310276","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":"Reconsidering the male disadvantage in bronchopulmonary dysplasia: three exceptions.","authors":"Theodore Dassios, Charles C Roehr","doi":"10.1038/s41390-025-04238-z","DOIUrl":"https://doi.org/10.1038/s41390-025-04238-z","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310279","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":"Family reflections: congenital diaphragmatic hernia.","authors":"Honor Mijatovic","doi":"10.1038/s41390-025-04184-w","DOIUrl":"https://doi.org/10.1038/s41390-025-04184-w","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294773","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":"Pulmonary perfusion with dynamic PEEP recruitment or sustained inflation at birth in preterm lambs.","authors":"Joseph J Smolich, Kelly R Kenna, Magdy Sourial, Don Black, Anna Lavizzari, David G Tingay","doi":"10.1038/s41390-025-04183-x","DOIUrl":"10.1038/s41390-025-04183-x","url":null,"abstract":"<p><strong>Background: </strong>Sustained inflation (SI) and dynamic PEEP recruitment (dynPEEP) aim to facilitate preterm lung aeration, but the effect of dynPEEP on pulmonary arterial (PA) blood flow after birth is unknown.</p><p><strong>Methods: </strong>Preterm (128 ± 1 day) fetal lambs instrumented with left PA and ductus arteriosus flow probes underwent positive-pressure ventilation (PEEP 8 cmH₂O) after early cord clamping, preceded by either (1) SI at 40 cmH₂O for 35 ± 3 s (n = 7) or (2) dynPEEP (n = 9) over 275 ± 23 s, comprising 2 cmH₂O step rises in PEEP from 6 to 18 cmH₂O followed by 2 cmH₂O decrements to 6 cmH₂O PEEP, then lung re-recruitment at 18 cmH₂O PEEP. Hemodynamics were recorded for 30 min after birth.</p><p><strong>Results: </strong>During dynPEEP, PA blood flow increased linearly (P < 0.001) except for plateaus (1) between 12 cmH₂O PEEP on the escalation limb and 14 cmH₂O PEEP on the de-escalation limb, and (2) during lung re-recruitment. By contrast, PA flow increased during SI (P < 0.02), and was then briefly unchanged before rising linearly (P < 0.001). Consequently, post-birth rises in PA flow diverged between groups (P < 0.001), with this flow lower during dynPEEP by lung re-recruitment (P ≤ 0.048), but subsequently similar between groups.</p><p><strong>Conclusions: </strong>Only transient temporal differences in PA blood flow occur between SI and dynPEEP lung recruitment maneuvers at birth.</p><p><strong>Impact: </strong>This study shows that a dynamic escalation and de-escalation positive end-expiratory pressure (PEEP) lung recruitment maneuver applied during the phase of rapidly-increasing pulmonary blood flow in the immediate period after preterm birth does not impede the peak of this flow increase, although transient plateauing of pulmonary flow occurs at high levels of PEEP This response contrasts with a sustained reduction of pulmonary blood flow reported during and after elevations in PEEP following stabilization of increased pulmonary perfusion after birth This preclinical study provides evidence that dynamic PEEP lung recruitment immediately after birth does not impair subsequent pulmonary perfusion.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286106","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":"Association between the risk of necrotizing enterocolitis and intrauterine growth: a multicenter cohort study.","authors":"Dan Dang, Siyuan Jiang, Joseph Y Ting, Xiaoping Lei, Xinyue Gu, Wenhao Zhou, Lizhong Du, Yun Cao, Shoo Kim Lee, Hui Wu, Jianguo Zhou","doi":"10.1038/s41390-025-04039-4","DOIUrl":"https://doi.org/10.1038/s41390-025-04039-4","url":null,"abstract":"<p><strong>Background: </strong>Despite the established correlation between small for gestational age (SGA) and heightened necrotizing enterocolitis (NEC) risk, the relationship between intrauterine growth, including SGA, and the occurrence of NEC remains ambiguous.</p><p><strong>Methods: </strong>This study utilized data of very preterm infants (VPIs) with a gestational age <32 weeks from the Chinese Neonatal Network cohort study. Intrauterine growth status was categorized through birthweight (BW) percentile delineated by the Fenton growth chart.</p><p><strong>Results: </strong>The cohort comprised 23,702 VPIs containing 1186 cases of NEC. A non-linear relationship between BW percentiles and death or NEC was identified. Infants with a BW percentile ≤23rd showed an increased risk of death or NEC. The multivariate analysis indicated a significantly higher risk of death or NEC in infants categorized between the 10th and 23rd percentiles (adjusted odds ratio [aOR] = 1.41; 95% confidence interval [CI], 1.22-1.63) and those below 10th percentile (aOR = 2.09; 95% CI, 1.74-2.52), comparing with infants in the above 23rd percentile group. Subgroup analyses yielded analogous results.</p><p><strong>Conclusions: </strong>Intrauterine growth restriction significantly increases the risk of mortality or NEC among VPIs. The increased risk also extends to infants, particularly those within the 10th to 23rd percentile range, emphasizing the need for heightened surveillance and care.</p><p><strong>Impact: </strong>This study explores the relationship between intrauterine growth and the occurrence of necrotizing enterocolitis (NEC). In this multicenter cohort study that included 23,702 very preterm infants (VPIs), a non-linear relationship between birth weight percentiles and death or NEC was identified. Infants with a birth weight percentile at or below 23rd showed an increased risk of death or NEC. Intrauterine growth restriction significantly increases mortality or NEC risk among VPIs with birth weight at or below the 23rd percentile. This risk extends to infants, particularly within the 10th to 23rd percentile range, highlighting the need for heightened surveillance and care.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294772","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":"Early prediction of bronchopulmonary dysplasia: comparison of modelling methods, development and validation studies.","authors":"Heloise Torchin, Paula Dhiman, Pierre-Yves Ancel, Xavier Durrmeyer, Pierre-Henri Jarreau, Alexandra Nuytten, Patrick Truffert, Jennifer Zeitlin, Gary S Collins","doi":"10.1038/s41390-025-04170-2","DOIUrl":"https://doi.org/10.1038/s41390-025-04170-2","url":null,"abstract":"<p><strong>Background: </strong>Machine-learning methods are gaining in popularity to predict medical events but their added value to other methods is still to be determined. We compared performances of clinical prediction models for bronchopulmonary dysplasia (BPD) or death in very preterm infants using logistic regression and random forests methods.</p><p><strong>Methods: </strong>Two population-based cohorts of very preterm infants were used: EPIPAGE-2 (France, 2011) for development and internal validation and EPICE (Europe, 2011) for external validation. Eligible infants were born before 30 weeks' gestation and admitted in neonatal units. BPD was defined as any respiratory support at 36 weeks postmenstrual age. Candidate predictors were available shortly after birth or at day 3. Logistic regression and random forest models performance was assessed in terms of discrimination (c-statistic) and calibration plots.</p><p><strong>Results: </strong>Prevalence of BPD/death was 32.1% (668/1923) in EPIPAGE-2 and 41.0% (1368/3335) in EPICE. At both time points, logistic regression and random forest models showed similar performance during internal validation. At birth, external validation in EPICE showed good discrimination (logistic regression model: c-statistics 0.81, 95% CI 0.80-0.83; random forest: 0.80, 95% CI 0.79-0.81) but both models underestimated the probability of BPD/death. Model performances were heterogeneous throughout European regions.</p><p><strong>Conclusions: </strong>Both modelling methods performed similarly to predict BPD/death shortly after birth in very preterm children.</p><p><strong>Impact: </strong>Whether machine-learning methods predict better short-term respiratory outcomes in very preterm infants than logistic regression models is debated. Random forest-based prediction models did not perform better than logistic regression to predict bronchopulmonary dysplasia or death shortly after birth in very preterm infants. Calibration performances varied among European countries. While offering the same performance, regression models are easier to understand, to disseminate and to apply to different populations.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286103","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":"Gambling and adolescents: a public health crisis demanding immediate action.","authors":"Luana Stangherlin Dos Santos, Júlio César Claudino Dos Santos","doi":"10.1038/s41390-025-04196-6","DOIUrl":"https://doi.org/10.1038/s41390-025-04196-6","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286104","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":"Prevention of unplanned extubation in neonates with silk tie securement.","authors":"Tetyana H Nesterenko, Firas Saker, Daniel Kubiak, John Dickson, Amanda L Sheppard, Nicole Saliba, Katherine L Fedor, Mohamed A Mohamed, Hany Aly","doi":"10.1038/s41390-025-04168-w","DOIUrl":"https://doi.org/10.1038/s41390-025-04168-w","url":null,"abstract":"<p><strong>Background: </strong>Unplanned extubation (UE) is the fourth most common adverse event in neonatal intensive care units (NICUs) and remains a significant global challenge. Standardizing endotracheal tube (ETT) maintenance could reduce UE rates to 0.5-1.0 events per 100 non-tracheostomy ventilation days. This quality improvement (QI) project aimed to reduce the UE rate to below 1.0 event per 100 non-tracheostomy ventilation days within 12 months.</p><p><strong>Methods: </strong>Using a QI methodology, we conducted four Plan-Do-Study-Act (PDSA) cycles, including frequent ETT securement evaluations, ETT stabilization during procedures, audits of chest radiographs, and the use of a silk tie for ETT reinforcement. Statistical process control charts monitored progress.</p><p><strong>Results: </strong>Baseline UE rate was 1.73 events per 100 non-tracheostomy ventilation days. The first three PDSA cycles (January 2019-May 2020) produced a non-significant signal for reduced UE to 0.88. After introducing the silk suture tie in PDSA cycle 4, the rate significantly declined to 0.58 and was sustained from October 2020 to December 2021. A further special cause variation occurred from February to December 2022 with UE reduction to 0.06.</p><p><strong>Conclusions: </strong>A multidisciplinary approach and silk suture tie intervention significantly reduced and sustained one of the lowest reported UE rates, enhancing ETT securement and patient safety.</p><p><strong>Impact: </strong>Unplanned extubation (UE) events are not uncommon in the neonatal intensive care unit. This project demonstrates that the lowest reported UE rates in neonatal ICUs are possible without incurring additional costs or requiring new securement devices. The success of this project underscores the importance of standardizing care, reducing variability, and fostering a multidisciplinary, collaborative approach. The silk tie enhancement for ETT stabilization offers a practical, scalable solution to prevent UEs and improve neonatal care.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286105","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 social media-delivered intervention for motor delays: stage-Ib randomized clinical trial and implementation exploration.","authors":"Nathalie L Maitre, Larken Marra, William Kjeldsen, Lisa J H Pinson, Rachel Byrne, Zhulin He, Melissa M Murphy","doi":"10.1038/s41390-025-04151-5","DOIUrl":"https://doi.org/10.1038/s41390-025-04151-5","url":null,"abstract":"<p><strong>Background: </strong>Early motor delays are common and can have lasting consequences. Gaps between delay identification and caregiver support often cause stress. We hypothesized that a social-media-delivered intervention supporting caregivers of children with motor delays could improve understanding of development/parenting, and self-efficacy; we explored effects on caregiver stress, implementation fit/feasibility.</p><p><strong>Methods: </strong>This single-blind Phase 1b randomized controlled trial with wait-list control and implementation exploration included caregivers of children 3-36 months corrected age (CA) with motor delays. Interactions occurred via Facebook private groups and REDCap. Knowledge questionnaires, parental-self efficacy scale, Parenting Stress Index and Developmental Assessment of Young Children physical domain (DAYC-2 Phys) were administered pre/post-intervention.</p><p><strong>Results: </strong>Within the cohort, caregivers (n = 31 intervention, n = 31 waitlist) reported that 13% of children had only motor delays, 63% also had diagnosed cerebral palsy, and 24% also had other types of complex medical conditions (e.g., chronic lung disease, feeding disorder). The intervention group had greater knowledge gains and fewer instances of parental distress scores in the clinical range (p < 0.01) with no effects on self-efficacy. Feasibility and acceptability were high for delivery format and content; positive perceptions, sense of connection and empowerment predominated. Negative feedback concerned technical issues and study design.</p><p><strong>Conclusion: </strong>This social-media-delivered intervention showed social connection was valued and may reduce parent distress. Implementation and future research are well supported.</p><p><strong>Trial registration number and name: </strong>NCT05542251, Education Program for Caregivers of Children with Gross Motor Delays.</p><p><strong>Impact: </strong>Social connection is valued by families of young children with motor delays and impairments. Interventions leveraging social media can decrease stress and increase knowledge for these families. Social media delivered interventions are feasible and acceptable to families as they wait for specialized early intervention services. Further studies are needed to research whether social-medial delivered interventions can also improve the motor outcomes of children with motor delays.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286102","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}