Pediatric Research最新文献

{"title":"Reduced atelectasis does not establish comparative safety of lower pre-extubation oxygen.","authors":"Edgar Fabián Manrique-Hernández, Jorge L Alvarado-Socarras","doi":"10.1038/s41390-026-05572-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05572-6","url":null,"abstract":"<p><strong>Impact: </strong>The trial shows that 50% inspired oxygen reduces immediate ultrasound-detected atelectasis compared with 100% oxygen before extubation, but it was not designed or powered to compare clinical safety. Zero desaturation events among 32 children given 50% oxygen are compatible with an underlying risk of up to about 9%, so an adequately powered non-inferiority evaluation is needed before a safety claim is made.</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":"149113318","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":"Enabling evidence generation for extremely preterm neonates: the use of neonatal real-world data.","authors":"Ryan Kilpatrick, Rachel G Greenberg, Danielle Boyce, Kanwaljit Singh, Jonathan Davis","doi":"10.1038/s41390-026-05561-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05561-9","url":null,"abstract":"<p><p>Extremely low gestational age neonates (ELGANs), born before 28 weeks of gestation, face the greatest burden of neonatal mortality and morbidity, yet remain among the most underserved populations in clinical research. Most medications administered in the neonatal intensive care unit lack adequate safety, efficacy, and dosing data, and no major therapeutic advances have improved preterm survival since the introduction of surfactant in the early 1990s. Real-world data (RWD) presents a promising opportunity to bridge these evidence gaps. ELGANs are ideal candidates for RWD research given the extraordinary density and granularity of data generated during prolonged neonatal intensive care unit stays, ethical and practical barriers to traditional clinical trials, and wide variations in clinical practice. In this review, we examine how ELGANs may benefit from RWD, describe the current landscape of common data models and their neonatal limitations, propose a minimum neonatal-specific variable set, and explore the roles of key stakeholders in building RWD infrastructure. We further highlight the regulatory applications of RWD including external controls, target trial emulation, pharmacovigilance, and natural history studies. Realizing the potential of RWD for ELGANs requires coordinated investment from clinicians, informaticians, regulators, and families to improve outcomes for the most vulnerable patients in medicine. IMPACT: ELGANs are an ideal population for RWD research given the extraordinary density of longitudinal NICU data, ethical and practical barriers to traditional randomized trials, and wide variations in evidence-based clinical practice. Current common data models were not designed with neonatal complexity in mind, lacking native support for maternal-infant linkage, continuous physiologic data, weight-based medication dosing, and long-term neurodevelopmental follow-up. A coordinated, multi-stakeholder framework involving neonatologists, bedside caregivers, informaticians, regulators, and families is essential to building the RWD infrastructure needed to improve outcomes for ELGANs.</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":"149113354","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":"STARZ Scoring in Very Low Birth Weight (VLBW) neonates: validation and risk-stratification for neonatal acute kidney injury.","authors":"Joy Owens, Meredith P Schuh","doi":"10.1038/s41390-026-05557-5","DOIUrl":"https://doi.org/10.1038/s41390-026-05557-5","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113329","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":"Life after the NICU: targeting modifiable factors to improve neurodevelopmental outcomes in children born extremely preterm.","authors":"Rhandi Christensen, Daniela Salvo, Kathryn Y Manning, Tricia Williams, Mehmet N Cizmeci","doi":"10.1038/s41390-026-05538-8","DOIUrl":"https://doi.org/10.1038/s41390-026-05538-8","url":null,"abstract":"<p><p>Infants born preterm are at risk for neurodevelopmental delays and impairments, with the greatest risk for those born extremely preterm or at the limits of viability. Developmental surveillance in neonatal neurodevelopmental follow-up programs is essential for infants born preterm as it allows for early identification of developmental delays and referral to intervention services. Previous studies have identified modifiable home and environmental factors that can alter the neurodevelopmental trajectory of children born preterm. In this review, we discuss how targeting modifiable factors can improve outcomes in the most vulnerable infants born extremely preterm or at the limits of viability. We present The 6 Ps to Promote Positive Neurodevelopmental Outcomes in Prematurity, including post-discharge follow-up in neonatal neurodevelopmental programs, providing enriched environments, physical environment, parent education, parenting style and parent wellness. As parents prepare to go home from the NICU they are faced with uncertainty about their child's future outcomes. Parents often ask, \"what can we do for our baby?\" We provide evidence-informed recommendations for counseling families during the transition home to enable parents to actively participate in optimizing their child's neurodevelopmental outcomes. IMPACT: Targeting modifiable home and environmental factors may improve neurodevelopmental outcomes in infants born extremely preterm. This article presents The 6 Ps to Promote Positive Neurodevelopmental Outcomes in Prematurity: post-discharge follow-up in neonatal neurodevelopmental programs, providing enriched environments, physical environment, parent education, parenting style and parent wellness. During the transition from NICU to home, parents should be counseled on these modifiable factors and encouraged to actively participate in optimizing their child's neurodevelopmental outcomes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113372","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":"Target tidal volume incompletely describes mechanical dose during high-frequency oscillatory ventilation.","authors":"Emily M Ostermaier, Weerapong Lilitwat","doi":"10.1038/s41390-026-05571-7","DOIUrl":"https://doi.org/10.1038/s41390-026-05571-7","url":null,"abstract":"<p><strong>Impact: </strong>Volume guarantee can stabilize oscillatory tidal volume, but the target value alone does not describe the mechanical conditions required to achieve it. Bench data show that frequency, pressure amplitude, mean airway pressure, inspiratory-expiratory ratio, and airway resistance influence delivered tidal volume. Future HFOV-volume guarantee studies should therefore report target and achieved tidal volume together with frequency, amplitude, airway resistance proxies, endotracheal tube size, and carbon dioxide response.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113345","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":"CEPAS abstracts.","authors":"","doi":"10.1038/s41390-026-05383-9","DOIUrl":"10.1038/s41390-026-05383-9","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":"1-123"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063582","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":"Prenatal exposure to hypertensive disorders and adolescent brain white matter development.","authors":"Vida Rebello, Yinging Xia, Nicole M Talge, Hedyeh Ahmadi, Andrew O Odegaard, Veronica M Vieira, Marybel R Gonzalez, Eric Kan, Bernadette Boden-Albala, Kristina A Uban","doi":"10.1038/s41390-026-05511-5","DOIUrl":"https://doi.org/10.1038/s41390-026-05511-5","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy (HDP) are associated with altered in utero neurodevelopment, yet long-term impact on adolescent white matter architecture remains unclear, particularly by HDP subtype and sex. While preeclampsia/eclampsia (P/E) is clinically more severe, pregnancy-related hypertension (PR-HTN) may involve longer in-utero exposure to hemodynamic stress. This study examined how distinct HDP exposures influence longitudinal white matter measures in adolescents.</p><p><strong>Methods: </strong>Using a longitudinal cohort with two MRI timepoints (baseline ages 9-11 years; 2-year follow-up ages 11-13.8 years), we modeled fiber volume (FV) and fractional anisotropy (FA) using linear mixed-effects models. Analyses were sex-stratified and adjusted for prenatal exposures, maternal age, race/ethnicity, and income. False discovery rate (FDR) correction was applied.</p><p><strong>Results: </strong>In female adolescents, PR-HTN was significantly associated with lower FV across bilateral association, projection, and limbic pathways, alongside reduced FV and FA in the corpus callosum and forceps major/minor (q < 0.05). Conversely, P/E exposure showed no FDR-significant associations. No significant associations were observed in males for either HDP subtype.</p><p><strong>Conclusion: </strong>Chronic in-utero exposure to PR-HTN, rather than acute P/E, is associated with widespread reductions in white matter structural integrity in females. These findings support subtype-specific and developmentally sensitive associations between HDP exposure and offspring brain development.</p><p><strong>Impact: </strong>This study demonstrates that pregnancy-related hypertension, a traditionally \"milder\" disorder, has more pronounced long-term impacts on adolescent white matter scaffolding than preeclampsia/eclampsia. The results highlight a female-specific vulnerability to chronic prenatal hypertensive stress, manifesting as reduced volumetric and microstructural integrity in critical commissural and association white matter tracts. These findings shift the clinical focus toward the neurodevelopmental risks of chronic gestational hypertension, suggesting that maternal cardiovascular health throughout the entire pregnancy is a vital determinant of offspring brain development.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113338","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 Goldilocks zone of optimal antimicrobial stewardship in preterm infants.","authors":"Eleanor J Molloy, Laura Johnson, Mark Klebanoff, David Tingay, James L Wynn","doi":"10.1038/s41390-026-05558-4","DOIUrl":"https://doi.org/10.1038/s41390-026-05558-4","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113398","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 murmur auscultation and tele-consultation: importance of signal quality and classification.","authors":"Lizelle V van Wyk, Jacomine Grobler","doi":"10.1038/s41390-026-05537-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05537-9","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113382","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":"Brainstem size in extremely preterm infants: reference values and association with neurodevelopmental outcomes.","authors":"Julia Buchmayer, Paul Zeugswetter, Renate Fuiko, Gregor Kasprian, Vito Giordano, Katrin Klebermaß-Schrehof, Victor Schmidbauer, Sophie Stummer, Angelika Berger, Katharina Goeral","doi":"10.1038/s41390-026-05529-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05529-9","url":null,"abstract":"<p><strong>Background and objectives: </strong>Extremely preterm infants are at high risk for neurodevelopmental impairment. The brainstem plays a critical role in early development. This study aimed to establish reference values for two-dimensional brainstem measurements on cerebral magnetic resonance imaging (cMRI) at term-equivalent age (TEA), assess the impact of severe neonatal brain injury, and examine associations with neurodevelopment.</p><p><strong>Methods: </strong>In this retrospective cohort study, preterm infants underwent routine cMRI at TEA. Standardized midsagittal brainstem measurements were obtained. Reference values and z-scores were derived from infants without severe brain injury (high-grade IVH, CBH, or cystic WMI). In the reference cohort, associations with Bayley-III outcomes at 2 years' corrected age were evaluated using multivariable regression. Brainstem z-scores were compared between infants with and without severe brain injury.</p><p><strong>Results: </strong>Reference values were established for 242 infants born between 22 + 1 and 27 + 6 weeks' gestation. Brainstem size increased with gestational age and was significantly smaller in infants with severe brain injury. Higher brainstem z-scores were independently associated with better cognitive (adjusted β = 3.56, 95% CI: 0.44-6.69) and motor (adjusted β = 2.80, 95% CI: 0.39-5.22) outcomes.</p><p><strong>Conclusions: </strong>Brainstem size was associated with neonatal brain injury and later neurodevelopment, supporting its potential as a clinically applicable cMRI biomarker in extremely preterm infants.</p><p><strong>Impact: </strong>Reference values and z-scores for two-dimensional brainstem measurements at term-equivalent age in extremely preterm infants without severe brain injury. Reduced brainstem size in infants with severe brain injury, and association with cognitive and motor outcomes at 2 years' corrected age. Brainstem size is a simple and reproducible MRI biomarker.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081902","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}