Pediatric Research最新文献

{"title":"Development and Validation of an Electronic Fluid Balance Calculator for Critically Ill Children.","authors":"Denise C Hasson, James D Odum, Ulka Kothari, Ami J Shah, Chloe G Braun, Celeste G Dixon, Julie C Fitzgerald, Adam C Dziorny","doi":"10.1038/s41390-026-05496-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05496-1","url":null,"abstract":"<p><p>Our objective was to describe and validate the performance of a real-time cumulative fluid balance (CFB) calculator built into the electronic health record (EHR). We performed a retrospective cohort study in the cardiac and general medical-surgical pediatric ICUs of a single center and included all encounters between June-November 2025. Our outcome of interest was the daily calculated difference between the real-time %CFB calculator and a documented %CFB (from retrospective de-identified data extracted from the EHR) from the first fourteen ICU days. We calculated the number (%) of encounters whose difference varied by > 0.1%CFB and assessed correlation using Pearson correlation coefficients. We collected 468 unique hospital encounters spanning 154 days, making up 2041 ICU patient-days. The real-time %CFB calculator matched the documented %CFB within < 0.1% CFB on 1971 (96.6%) days. There were 34 encounters, 20 pediatric cardiac ICU and 14 pediatric medical/surgical ICU, whose difference was > 0.1%, correlation (R²) > 0.99. In conclusion, we developed a real-time %CFB calculator within the EHR and validated its accuracy in an attempt to provide evidence of its reliability for clinical use. A %CFB calculator that indexes net fluid balance to weight and is readily available may bring greater attention to clinical fluid overload.</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":"149081254","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":"Accumulating safety data for remote ischemic conditioning in acute pediatric neurological conditions.","authors":"Brian T Kalish, Nicola J Robertson","doi":"10.1038/s41390-026-05402-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05402-9","url":null,"abstract":"","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":"149075398","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":"Repositioning early head circumference to predict catch-up growth in SGA infants.","authors":"Qian Chen, Minghui Xiong, Li Chen, Yuan Ding, Ying Dai, Xiao Liu, Zhiyang Jiang, Yuanfeng Zhong, Zhanzhan Zhang, Yannan Wan, Qian Zhang, Min Guo, Lin Zhu, Xuan Zhang","doi":"10.1038/s41390-026-05527-x","DOIUrl":"https://doi.org/10.1038/s41390-026-05527-x","url":null,"abstract":"<p><strong>Background: </strong>Early identification of catch-up growth (CUG) in small-for-gestational-age (SGA) infants is critical. Head circumference at the first postnatal visit may capture distinct dimensions of early growth programming. We investigated its association with time to weight and length CUG.</p><p><strong>Methods: </strong>A retrospective cohort of 1338 SGA infants with an initial visit <60 corrected days was followed to 2 years. Time-to-CUG was analyzed using Cox models; nonlinearity was assessed via restricted cubic splines and segmented regression.</p><p><strong>Results: </strong>Head circumference Z-score was independently associated with both outcomes. For weight CUG, a non-linear relationship was observed (P = 0.006), with a threshold at -2.42 (below: HR 1.74, 95% CI 1.18, 2.58; above: HR 1.59, 95% CI 1.44, 1.75). For length CUG, the relationship was linear (HR 1.74, 95% CI 1.59, 1.90). Preterm infants showed a stronger association for weight CUG (P = 0.01).</p><p><strong>Conclusions: </strong>Early head circumference Z-score independently predicts CUG timing in SGA infants, exhibiting a non-linear threshold effect for weight recovery and a linear association for linear growth. This routinely available measure offers a pragmatic tool for risk stratification in SGA follow-up.</p><p><strong>Impact: </strong>Early postnatal head circumference measured at the first child health visit (<60 days) independently predicts catch-up growth timing in SGA infants, providing a pragmatic, routinely available tool for risk stratification in follow-up protocols. A non-linear threshold for weight catch-up was identified at Z-score -2.42 (HR 1.74 below; HR 1.59 above), pinpointing a high-risk subgroup requiring intensive monitoring, while the linear association with length catch-up was consistent across all head sizes. Preterm SGA infants showed stronger weight catch-up associations (P = 0.01), highlighting their vulnerability and need for prioritised intervention.</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":"149081338","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":"Sildenafil in bronchopulmonary dysplasia-associated pulmonary hypertension: developmental and translational insights.","authors":"Jenyfer Fuentes-Mendoza, Mateo Sernaqué-Paz, Daniela Cruz-Riquelme, Carlos Zavaleta-Corvera, Angel Samanez-Obeso","doi":"10.1038/s41390-026-05480-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05480-9","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) is increasingly viewed as a developmental pulmonary vascular disorder rather than a purely reactive vasoconstrictive complication of chronic lung disease. It involves impaired angiogenesis, reduced pulmonary vascular surface area, alveolar simplification, and progressive right ventricle-pulmonary artery uncoupling. Sildenafil, a phosphodiesterase type 5 inhibitor, is widely used because it enhances nitric oxide-cyclic guanosine monophosphate signaling and may reduce pulmonary vascular tone. However, neonatal-specific evidence remains limited, dosing approaches are heterogeneous, and its long-term effects on vascular remodeling and clinical outcomes are uncertain. This narrative review integrates developmental biology, translational evidence, clinical studies, pharmacokinetics, and safety considerations to critically evaluate sildenafil in BPD-PH. Current data support short-term improvements in echocardiographic hemodynamics and oxygenation in selected infants, but do not demonstrate durable remodeling reversal or improved survival. Experimental studies suggest effects on endothelial survival, smooth muscle proliferation, angiogenic signaling, and oxidative stress, although relevance to human preterm infants remains incompletely validated. Developmental pharmacokinetics, including CYP3A maturation, weight, postnatal age, route, and drug interactions, contribute to variable exposure. Sildenafil use should therefore be individualized, phenotype-guided, and evaluated in future trials with pharmacokinetic-guided dosing and longitudinal outcomes. IMPACT: Reframes bronchopulmonary dysplasia-associated pulmonary hypertension as a disorder of impaired pulmonary vascular development rather than a purely reactive vasoconstrictive process. Integrates developmental biology, translational evidence, and neonatal pharmacokinetics to critically evaluate sildenafil beyond its traditional vasodilatory role. Highlights the need for precision pharmacology approaches and pharmacokinetic-guided dosing to optimize therapeutic strategies in preterm infants.</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":"149081550","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":"Micro- and nanoplastics in pediatric health: from placental transfer to neurodevelopmental outcomes.","authors":"Saheli Chatterjee Misra, Kaushik Mukhopadhyay","doi":"10.1038/s41390-026-05419-0","DOIUrl":"https://doi.org/10.1038/s41390-026-05419-0","url":null,"abstract":"<p><strong>Background: </strong>Micro- and Nano plastic (MNP) contamination is an emerging environmental health concern with potential implications for pediatric health. Due to developmental susceptibility and higher relative exposure, fetuses, infants, and young children may be particularly vulnerable to MNP-related toxicity.</p><p><strong>Method: </strong>This narrative review integrates evidence from animal models, human biomonitoring, and mechanistic studies to evaluate prenatal and early-life exposure pathways and potential neurodevelopmental consequences of MNPs. The synthesis addresses placental transfer, postnatal ingestion, inhalation, dermal exposure, and advances in analytical techniques for detection of biomarkers.</p><p><strong>Results: </strong>Human studies demonstrate the presence of microplastics in the placenta, amniotic fluid, cord blood, and feces, supporting transplacental and early-life exposure. Experimental evidence indicates that nanoplastics can cross biological barriers and may induce oxidative stress, inflammation, endocrine disruption, and altered neurotransmitter signaling. Animal studies consistently show structural and behavioral neurodevelopmental changes following early-life exposure. Emerging epidemiological data suggest associations between urinary microplastic markers and behavioral or cognitive outcomes in children, although causality remains unestablished.</p><p><strong>Conclusion: </strong>Current evidence indicates that children are exposed to MNPs during critical developmental windows, with biologically plausible mechanisms linking exposure to adverse neurodevelopmental outcomes. Longitudinal human studies and child-specific dose-response data are urgently needed to inform risk assessment and guide public health strategies.</p><p><strong>Impact: </strong>Children represent a uniquely vulnerable population to microplastic and nanoplastic exposure, beginning with placental transfer and continuing through ingestion and inhalation in early life. Our findings highlight the urgent need for standardized detection methods for microplastic exposure and longitudinal studies in children linking exposure to neurodevelopmental outcomes. Protecting children from micro- and nanoplastic toxicity represents public health priority for future generations.</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":"149081346","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":"Identifying and addressing gaps in recognition of cerebral/cortical visual impairment risk in the NICU.","authors":"Ceilidh Smith, Hoda El-Shibiny, Lacey Smith, Carmina Erdei, Silvia Patrizi, Gena Heidary, Lotfi B Merabet, Mohamed El-Dib","doi":"10.1038/s41390-026-05456-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05456-9","url":null,"abstract":"<p><strong>Impact: </strong>Cerebral/Cortical visual impairment (CVI) is a common sequela of perinatal neurological injury and is under-recognized in early life. There is no standardized approach to identifying risk for CVI for infants hospitalized in the NICU. In a local survey, NICU providers demonstrated recognition of CVI risk factors but variability in risk stratification, referral practices, and family communication strategies. A structured, risk-based clinical practice guideline may improve early recognition, standardize care, and support timely referral and intervention for high-risk infants.</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":"149081390","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":"Does use of acetaminophen and/or NSAIDs increase the risk of developing bronchopulmonary dysplasia?","authors":"Rakesh Sharma, Vineet Bhandari","doi":"10.1038/s41390-026-05526-y","DOIUrl":"https://doi.org/10.1038/s41390-026-05526-y","url":null,"abstract":"","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":"149081394","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":"Deep learning for coronary arteries identification and measurement in pediatric echocardiography.","authors":"Li-Ping Lai, Zuo-Lin Li, Qing-Fa Liu, Jia-Yang Jiang, Liang-Qin Wang, Ming-Yu He, Min Lin, Xiao-Lian Li, Shui-Ping Li","doi":"10.1038/s41390-026-05472-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05472-9","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery lesions are a critical complication of Kawasaki disease. This study developed a deep learning model for the automated identification and measurement of coronary arteries in pediatric echocardiograms to facilitate accurate assessment.</p><p><strong>Methods: </strong>We collected 2314 echocardiograms from children with suspected or diagnosed Kawasaki disease. A YOLOv8 model was trained on a curated set of 3000 images to identify the right coronary artery, left main coronary artery, left anterior descending artery, and left circumflex artery. 1500 standard images were selected to validate the model's measurement performance, and compared against physicians.</p><p><strong>Results: </strong>The AI model showed high identification performance on the test set, with the mean average precision for all coronary branches >80%. The identification rates were higher in toddlers and older children than in infants and in experts than in general physicians. The AI model demonstrated excellent agreement with expert physicians across all branches, with significantly shorter measurement time than manual methods.</p><p><strong>Conclusion: </strong>The AI model developed in this study demonstrated high accuracy in pediatric coronary artery identification and measurement, showing promise as an efficient and reliable assistive technology.</p><p><strong>Impact: </strong>A deep learning model was developed for automated identification and measurement of coronary arteries in pediatric echocardiography. It moves beyond existing identification-focused studies by solving the key challenge of automated, precise quantification. This AI model can serve as a valuable supplementary tool for standardizing echocardiographic evaluation and supporting quality control in clinical practice.</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":"149081157","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 moderate-to-severe BPD or death in preterm infants using minute-level respiratory monitoring and explainable machine learning.","authors":"Theolyne Louifi, Boris Delange, Mona Leroux, Patrick Pladys, Alain Beuchée","doi":"10.1038/s41390-026-05503-5","DOIUrl":"https://doi.org/10.1038/s41390-026-05503-5","url":null,"abstract":"<p><strong>Background: </strong>Early identification of extremely preterm infants at risk of moderate-to-severe bronchopulmonary dysplasia (BPD) or death remains challenging. We assessed whether minute-by-minute respiratory data from the first 24 h improves early prediction of this outcome using explainable machine learning.</p><p><strong>Methods: </strong>Retrospective cohort of 192 infants <30 weeks' gestation (2019-2024). Logistic regression, random forest, and XGBoost models were trained on 17 predictors and summarized 24-h respiratory data. Evaluation used AUROC, AUPRC, Brier score, calibration, and decision curves, with SHAP for interpretability.</p><p><strong>Results: </strong>Forty-five infants (23.4%) reached the composite endpoint. All models achieved comparable discrimination (AUROC 0.831-0.847). Random forest was selected as the headline model based on superior calibration (slope 1.016; ECE 0.053), lowest Brier score (0.131), and highest net benefit at decision thresholds ≥20%. Chest X-ray density, gestational age, and maximum FiO₂ were the top SHAP predictors in the headline model; gestational age achieved the highest cross-model rank. SHAP identified a gestational age threshold at 28 weeks, an FiO₂ risk step at 30-35%, and a U-shaped birthweight z-score effect.</p><p><strong>Conclusion: </strong>Combining early radiographic and high-frequency respiratory data with explainable machine learning enables well-calibrated BPD risk stratification on day 0-1. SHAP decomposition supports personalized care by distinguishing modifiable from non-modifiable risks.</p><p><strong>Impact: </strong>A machine learning model integrating respiratory monitoring, radiography, and perinatal variables from the first 24 h of life predicts moderate-to-severe BPD or death in very preterm infants with an AUROC of 0.831 and well-calibrated risk estimates (calibration slope 1.016). Unlike existing tools relying on data from day 7 or later, this day-1 approach significantly improves early prognosis beyond gestational age and birthweight alone. Providing net clinical benefit across a 10-30% threshold, it enables individualized, actionable risk stratification at the bedside, while clinical trajectories can still be modified.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075526","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":"Associations between school meal attendance, dietary intake and nutritional status in Spanish school-aged children: a cross-sectional study.","authors":"María Del Mar Uclés-Torrente, Gema Esperanza Ruiz-Gamarra, José Manuel Alcalde-Llergo, Manuel Vaquero-Álvarez, Isabel María Blancas-Sánchez, Pilar Aparicio-Martínez, Manuel Vaquero Abellán","doi":"10.1038/s41390-026-05442-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05442-1","url":null,"abstract":"<p><strong>Introduction: </strong>Childhood obesity and poor diet quality remain major public health challenges, highlighting the importance of school food environments. This study examined whether regular school cafeteria attendance is associated with healthier nutritional status and greater adherence to balanced dietary patterns among schoolchildren.</p><p><strong>Methods: </strong>A cross-sectional study of 171 children from five primary schools was conducted between January and March 2025. Anthropometric measurements, dietary quality, cafeteria attendance, menu nutritional composition and daily menu cost were assessed.</p><p><strong>Results: </strong>Children attending the school cafeteria showed slightly higher adherence to the Mediterranean diet than non-attendees (5.55 ± 3.32 vs. 4.80 ± 3.69). No significant differences were observed in BMI-for-age z scores or blood pressure (p > 0.05), although weight percentiles differed significantly (p < 0.001). Non-attendees reported higher energy intake (108.3% vs. 94.4%), lipid intake (128.5% vs. 105.9%; p = 0.006) and higher intake of several micronutrients (p < 0.05). Menu cost and school type were significantly associated with nutrient intake, anthropometric percentiles and Mediterranean diet adherence (p < 0.001).</p><p><strong>Conclusions: </strong>School cafeteria attendance was associated with modest differences in dietary quality but not anthropometric or blood pressure measures. Menu cost and school type may influence children's dietary patterns and nutritional outcomes.</p><p><strong>Impact: </strong>International research supports the potential benefits of school meal programmes for children, especially among food-insecure children. Children who eat at home had higher energy, lipid and micronutrient intake, suggesting a more energy-dense dietary pattern. School menu costs were significantly associated with multiple nutrient indicators, indicating a socioeconomic gradient in nutritional quality. School type (public, state-funded, or private) was linked to menu cost, anthropometric percentiles and diet quality. Findings support the role of school meal programmes as potential equity tools while highlighting the need to standardise minimum cost per child.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075485","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}