Pediatric Research最新文献

{"title":"A wake-up call for India to improve the TB elimination strategies.","authors":"Abhijit Poddar, S R Rao","doi":"10.1038/s41390-025-04014-z","DOIUrl":"https://doi.org/10.1038/s41390-025-04014-z","url":null,"abstract":"<p><strong>Impact: </strong>To augment a recent study highlighting the concerning rise in the global burden of multidrug-resistant tuberculosis (MDR-TB) among children and adolescents, this article presents the realities in India, stressing the urgent need for enhanced TB elimination strategies. It explores how insufficient data, rising air pollution, and recent U.S. sanctions impede the detection and control of pediatric TB burden including MDR-TBs in India. This article serves as a wake-up call for stakeholders to take decisive actions while facilitating future research and policy development. We provide targeted recommendations to address vulnerabilities and prevent a potential public health crisis.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634335","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":"Effect of different intranasal dexmedetomidine doses on pediatric postoperative delirium and agitation: network meta-analysis.","authors":"Huan Wu, Ping Wu, Liubo Xiang, Qianqian Huang, Yi Xiang, Jianshu Zhang, Zhihao Zhao, Tao Xu","doi":"10.1038/s41390-025-03851-2","DOIUrl":"https://doi.org/10.1038/s41390-025-03851-2","url":null,"abstract":"<p><strong>Objectives: </strong>Our research served to explore the influences of intranasal dexmedetomidine (DEX) at different doses on agitation, delirium, and other complications among children undergoing general anesthesia.</p><p><strong>Methods: </strong>A systematic search was executed in EMBASE, Cochrane Library, PubMed, and Web of Science, from the establishment of the database until February 12, 2024. The data analytics was implemented through R software and STATA version 16.0.</p><p><strong>Results: </strong>The final analysis incorporated 15 randomized controlled trials (RCTs) containing 1965 pediatric participants in total. The findings uncovered that relative to normal saline (NS), intranasal DEX at doses of 1 μg/kg [RR = 0.31, 95%CI = (0.17, 0.56)], 1.5 μg/kg [RR = 0.28, 95%CI = (0.09, 0.85)], and 2 μg/kg [RR = 0.18, 95%CI = (0.08, 0.36)] remarkably reduced the prevalence of post-anesthetic emergence agitation (EA) in children, with the 2 μg/kg dose demonstrating the highest effectiveness (SUCRA = 0.8997). Additionally, DEX at doses of 1 μg/kg [MD = -3.36, 95%CI = (-6.46, -0.44)] and 2 μg/kg [MD = -2.59, 95%CI = (-5.17, -0.32)] effectively reduced the Pediatric Anesthesia Emergence Delirium (PAED) score, with the 1 μg/kg dose ranking as the most efficacious according to SUCRA analysis (SUCRA = 0.8557).</p><p><strong>Conclusions: </strong>DEX prominently reduces the prevalence of emergence agitation and delirium. At doses of 2 μg/kg and 1 μg/kg, DEX effectively lowers the incidence of EA and PAED scores.</p><p><strong>Impact: </strong>Our research attempts to appraise the influence of discrepant doses of intranasal dexmedetomidine (DEX) on the incidence of postoperative agitation and delirium among children undergoing general anesthesia. The research elucidates the impact of various DEX doses on reducing postoperative agitation, PAED scores, and the need for postoperative analgesics, offering valuable guidance for selecting optimal dosing strategies in clinical practice. The research results support considering individual differences in children when choosing different doses of DEX to provide more suitable sedation and analgesia regimens, thereby improving postoperative recovery quality.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625253","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":"Microbes, metabolites, and inflammation: mapping the early neonatal intestinal landscape.","authors":"Muralidhar H Premkumar, Lovya George, Venkatesh Sampath","doi":"10.1038/s41390-025-04016-x","DOIUrl":"10.1038/s41390-025-04016-x","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625285","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":"Upper and lower airway microbiota across infancy and childhood.","authors":"Ariel J Hernandez-Leyva, Anne L Rosen, Christopher P Tomera, Elaina E Lin, Elikplim H Akaho, Allison M Blatz, William R Otto, Joey Logan, Lisa R Young, Rebecca M Harris, Samantha A Whiteside, Andrew L Kau, Audrey R Odom John","doi":"10.1038/s41390-025-03942-0","DOIUrl":"https://doi.org/10.1038/s41390-025-03942-0","url":null,"abstract":"<p><strong>Background: </strong>The upper and lower respiratory tracts feature distinct environments and responses affecting microbial colonization but investigating the relationship between them is technically challenging. We aimed to identify relationships between taxa colonizing the nasopharynx and trachea across childhood.</p><p><strong>Methods: </strong>We employed V4 16S rRNA gene sequencing to profile nasopharyngeal swabs and tracheal aspirates collected from 172 subjects between 20 weeks and 18 years of age. These samples were collected prior to elective procedures over the course of 20 weeks in 2020 from subjects enrolled in a cross-sectional study. After extraction, sequencing, and quality control, we studied the remaining 147 of 172 nasopharyngeal swabs and 95 of 172 tracheal aspirates, including 80 subject-matched pairs of samples.</p><p><strong>Results: </strong>Sequencing data revealed that the nasopharynx is colonized by few, often highly abundant taxa, while the tracheal aspirates feature greater diversity. The patterns of colonization identified in the nasopharynx correlate with subject age across childhood.</p><p><strong>Conclusion: </strong>Our data suggests that there are relatively few species that colonize both the nasopharyngeal tract and the trachea. Furthermore, we observe a pattern of change in the nasopharyngeal microbiota that is correlated with age, suggesting a possible developmental progression of the nasopharyngeal microbiota across childhood.</p><p><strong>Impact: </strong>The airway microbiota in childhood plays important roles in respiratory health and immune development. In this work, we report on paired nasopharyngeal swab and tracheal aspirate samples from a cross-sectional cohort of children from infancy to 18 years. We find that the upper and lower airway microbiota are unlikely to share taxa and do not correlate in terms of diversity. We show that the composition of the upper airway microbiota is strongly correlated with age, with a stereotypic developmental trajectory during childhood and adolescence. Our results inform our understanding of airway microbiota assembly and may be used to predict airway disease in young children.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615999","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":"Disrupting and restoring protection: maternal antibiotic exposure and neonatal IgA transfer via breastfeeding.","authors":"Olivier Gasser, Gergely Toldi","doi":"10.1038/s41390-025-03992-4","DOIUrl":"https://doi.org/10.1038/s41390-025-03992-4","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606040","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":"Improved linear growth after routine zinc supplementation in preterm very low birth weight infants.","authors":"Tina A Seidu, Luc P Brion, Roy Heyne, L Steven Brown, Theresa Jacob, Audrey Edwards, Cheryl S Lair, Myra H Wyckoff, David B Nelson, Dimitrios Angelis","doi":"10.1038/s41390-025-03935-z","DOIUrl":"10.1038/s41390-025-03935-z","url":null,"abstract":"<p><strong>Background: </strong>This study was designed (1) to compare growth, morbidity and mortality in < 33-week gestational age (GA) (very preterm, VPT) or very low birth weight (BW < 1500 grams, VLBW) infants before (Epoch-1) and after implementing routine enteral zinc (Zn) supplementation (Epoch-2) to meet recommendations, and (2) to assess serum Zn levels and associated variables.</p><p><strong>Methods: </strong>Single-center prospective cohort of 826 infants. The primary outcome was the change (Δ) in Z-scores of accurate length (Δlength_z), weight and head circumference from birth to discharge home.</p><p><strong>Results: </strong>In Epoch-2 vs Epoch-1 Δlength_z adjusted for confounding variables increased by 0.27 [95% confidence interval (CI) 0.13, 0.42, P < 0.001]. However, morbidity and mortality did not change. In Epoch-2 Zn decreased with GA and postnatal age: low ( < 0.74 mcg/mL) levels were observed in 51% infants. Retinopathy of prematurity (ROP) was independently associated with the lowest Zn [adjusted odds ratio 0.042 (CI 0.006, 0.306), area under the curve=0.928].</p><p><strong>Conclusion: </strong>Routine enteral Zn supplementation was independently associated with improved linear growth but did not prevent occurrence of low Zn. ROP was independently associated with the lowest Zn.</p><p><strong>Implications: </strong>Multicenter studies are needed to assess whether dosage of enteral Zn should be increased and whether Zn could help prevent ROP.</p><p><strong>Impact: </strong>Implementation of routine enteral zinc (Zn) supplementation was associated with improved linear growth from birth to discharge and a more frequent physiologic growth curve in preterm very low birth weight infants. Serum Zn levels decreased with gestational age and with postnatal age. Low serum Zn levels were observed frequently despite routine Zn supplementation as currently recommended, which suggests a need to re-evaluate current enteral zinc supplementation guidelines for this population. Retinopathy of prematurity among infants < 33 weeks' gestation was independently associated with low gestational age, low birthweight, stage of bronchopulmonary dysplasia and the lowest serum Zn level.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606108","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":"Advancing early risk prediction for preterm neonates with late-onset sepsis: a step toward precision medicine.","authors":"Spyridon Karageorgos, Ioannis Koutroulis","doi":"10.1038/s41390-025-03972-8","DOIUrl":"https://doi.org/10.1038/s41390-025-03972-8","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586458","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":"Can large language models assist with pediatric dosing accuracy?","authors":"Chedva Levin, Brurya Orkaby, Erika Kerner, Mor Saban","doi":"10.1038/s41390-025-03980-8","DOIUrl":"https://doi.org/10.1038/s41390-025-03980-8","url":null,"abstract":"<p><strong>Background and objective: </strong>Medication errors in pediatric care remain a significant healthcare challenge despite technological advancements, necessitating innovative approaches. This study aims to evaluate Large Language Models' (LLMs) potential in reducing pediatric medication dosage calculation errors compared to experienced nurses.</p><p><strong>Methods: </strong>This cross-sectional study (June-August 2024) involved 101 nurses from pediatric and neonatal departments and three LLMs (ChatGPT-4o, Claude-3.0, Llama 3 8B). Participants completed a nine-question survey on pediatric medication calculations. Primary outcomes were accuracy and response time. Secondary measures included seniority and group membership on accuracy.</p><p><strong>Results: </strong>Significant differences (P < 0.001) were observed between nurses and LLMs. Nurses averaged 93.14 ± 9.39 accuracy. Claude-3.0 and ChatGPT-4o achieved 100 accuracy, while Llama 3 8B was 66 accurate. LLMs were faster (15.7-75.12 seconds) than nurses (1621.2 ± 8379.3 s). The Generalized Linear Model analysis revealed task performance was significantly influenced by duration (Wald χ² = 27,881.261, p < 0.001) and interaction between relative seniority and group membership (Wald χ² = 3,938.250, p < 0.001), with participants achieving a mean total grade of 91.03 (SD = 13.87).</p><p><strong>Conclusions: </strong>Claude-3.0 and ChatGPT-4o demonstrated perfect accuracy and rapid calculation capabilities, showing promise in reducing pediatric medication dosage errors. Further research is needed to explore their integration into practice.</p><p><strong>Impact: </strong>Key Message Large Language Models (LLMs) like ChatGPT-4o and Claude-3.0 demonstrate perfect accuracy and significantly faster response times in pediatric medication dosage calculations, showing potential to reduce errors and save time. Addition to Existing Literature This study provides novel insights by quantitatively comparing LLM performance with experienced nurses, contributing to the understanding of AI's role in improving medication safety. Impact The findings emphasize the value of LLMs as supplemental tools in healthcare, particularly in high-stakes pediatric care, where they can reduce calculation errors and improve clinical efficiency.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586553","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":"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}