Pediatric Research最新文献

{"title":"Beyond eosinophils: systemic inflammation in pediatric allergic rhinitis.","authors":"Maria V Medeleanu, Olivia Fairfield, Julia E M Upton","doi":"10.1038/s41390-026-05524-0","DOIUrl":"https://doi.org/10.1038/s41390-026-05524-0","url":null,"abstract":"","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":"149075550","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":"Impact of a multidisciplinary intervention on resting and exercise respiratory functions in adolescents with obesity.","authors":"Bushra Fadel, Andrea Gaucherot, Bruno Pereira, Carole Egron, Sidoni Budjemma, Peebles Oost, Julie Masurier, Charlotte Cardenoux, Laurie Isacco, Yves Boirie, Martine Duclos, David Thivel, Valérie Julian","doi":"10.1038/s41390-026-05523-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05523-1","url":null,"abstract":"<p><strong>Background: </strong>Respiratory function (RF), body composition (BC), and cardiorespiratory fitness (CRF) links remain underexplored during multidisciplinary weight loss interventions (MWLI) in adolescents with obesity.</p><p><strong>Objectives: </strong>To investigate the impact of a 16-week MWLI on resting and exercise RFs and their associations with BC and CRF.</p><p><strong>Methods: </strong>RFs were measured in 92 adolescents (13.1 ± 1.19 years, 58%female, BMI 34.31 ± 4.93 kg/m²) by spirometry and at several intensities during cardiopulmonary exercise tests (CPET) before MWLI (T0) and after (T1). BC and CRF were measured by dual X-ray absorptiometry and peak oxygen consumption (VO_2peak).</p><p><strong>Results: </strong>Between T0 and T1, forced vital capacity (FVC), expiratory volume in one second (FEV1) and median expiratory flow (MEF25-75) increased (p < 0.001). Ventilatory efficiency increased (p < 0.01), while VO₂ and minute ventilation (VE) at similar calibrated exercise power outputs during exercise decreased. Body mass, total, trunk and visceral fat mass (FM) decreased while lean mass (LM) and CRF increased (p < 0.001). ΔFVC, ΔFEV1 and ΔMEF25-75 were associated positively with ΔLM% and ΔCRF (FVC, FEV1: p < 0.001; MEF25-75: p < 0.05) and negatively with Δtotal, Δtrunk and Δvisceral FM% (FVC, FEV1: p < 0.001; MEF25-75: p < 0.05). ΔVO₂ and ΔVE were associated negatively with ΔLM% and ΔCRF and positively with Δtotal, Δtrunk and Δvisceral FM% (p < 0.001).</p><p><strong>Conclusion: </strong>MWLI improves respiratory health and exercise tolerance in association with BC and CRF.</p><p><strong>Impact: </strong>This study is among the first to examine the effects of a multidisciplinary weight-loss intervention on both resting and exercise respiratory function in adolescents with obesity. The intervention improved respiratory function, body composition, and cardiorespiratory fitness. Respiratory improvements were associated with decreases in total, trunk, and visceral fat mass percentages and increases in lean mass percentage and cardiorespiratory fitness. The observed improvements in ventilatory efficiency and breathing reserve suggest a lower work of breathing and fewer ventilatory limitations during exercise, supporting multidisciplinary lifestyle interventions to improve respiratory health and exercise tolerance.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063580","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":"Enteric infections and childhood stunting: a systematic review and meta-analysis across four pathogen domains.","authors":"Rizqi Yanuar Pauzi, Muhammad Iqhrammullah, Suci Ihtiaringtyas, Annisa Nurul Ilmi, Laksita Widya Kumaratih, Puspita Tri Yuliana, Raghda Aisy Aqila, Elda Zaelita Nurul Raizma","doi":"10.1038/s41390-026-05520-4","DOIUrl":"https://doi.org/10.1038/s41390-026-05520-4","url":null,"abstract":"<p><strong>Background: </strong>Enteric infections have been implicated in childhood growth faltering, but the relative contribution of major enteric pathogen domains to stunting remains unclear.</p><p><strong>Methods: </strong>MEDLINE (via PubMed), Embase, Scopus, and Web of Science were systematically searched from inception to July 2026 for observational studies evaluating laboratory-confirmed enteric infections and childhood stunting. Random-effects meta-analyses were performed to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Pre-specified subgroup analyses and meta-regression were conducted to investigate potential sources of heterogeneity. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>Nineteen studies were included in the qualitative synthesis, of which 14 independent studies contributed to the quantitative meta-analysis. Overall, enteric infections were associated with significantly increased odds of childhood stunting (OR 1.94, 95% CI 1.33-2.82), although substantial between-study heterogeneity was observed (I² = 85.6%). Pathogen-specific subgroup analyses showed comparable associations across bacterial, viral, protozoal, helminthic, and non-specific parasitic infections, with no significant differences between pathogen domains. Meta-regression identified participant age and adjustment status as significant sources of between-study heterogeneity.</p><p><strong>Conclusion: </strong>Enteric infections were associated with increased odds of childhood stunting, although the certainty of the evidence was very low.</p><p><strong>Impact: </strong>Enteric infections were associated with significantly increased odds of childhood stunting among children living in low- and middle-income countries. Associations were strongest among children younger than two years, highlighting the vulnerability of the first 1000 days of life. Although pooled effect estimates varied across pathogen domains, no statistically significant differences were observed between pathogen groups, suggesting that multiple enteric infections may contribute to impaired child growth through shared biological pathways. These findings support integrating infection prevention, sanitation, and nutritional interventions into child stunting reduction programs.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063630","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 complications and sex modify the BMI-blood pressure relationship in children.","authors":"Aneta Sitek, Paulina Pruszkowska-Przybylska, Iwona Rosset, Marta Kurek, Joanna Mietlińska-Sauter, Magdalena Kobus, Justyna Karkus, Piotr Sękowski, Elżbieta Żądzińska","doi":"10.1038/s41390-026-05528-w","DOIUrl":"https://doi.org/10.1038/s41390-026-05528-w","url":null,"abstract":"<p><strong>Background: </strong>Prenatal factors may influence cardiovascular risk in offspring; however, their role in modifying the association between body mass index (BMI) and blood pressure (BP) in children remains unclear.</p><p><strong>Methods: </strong>This cross-sectional study included 769 children (6-13 years) without chronic conditions affecting BP. Systolic and diastolic BP were measured using a standardized protocol. Prenatal and familial data were obtained from parent-completed questionnaires. Associations were examined using hierarchical linear regression models with adjustment for age, sex, height, BMI, birth weight (z-score), and socioeconomic factors. Interaction terms were incorporated to assess effect modification.</p><p><strong>Results: </strong>BMI was the strongest predictor of both systolic and diastolic BP. Among prenatal factors, only pregnancy complications were associated with higher systolic BP (approximately +2.5 mmHg). No significant associations were observed for other prenatal variables. Interactions between BMI and pregnancy complications were identified for both BP measures. The BMI-BP association was stronger in children from uncomplicated pregnancies than in those exposed to prenatal complications. A BMI-sex interaction was also observed for systolic BP, with a stronger association in girls.</p><p><strong>Conclusions: </strong>BMI is a determinant of BP in children, but its effect may be modified by prenatal conditions. These findings support a role of developmental factors in shaping cardiovascular risk.</p><p><strong>Impact: </strong>Body mass index (BMI) is one of the major modifiable determinants of blood pressure in children; however, its influence varies across individuals. Pregnancy complications modify the BMI-blood pressure relationship, highlighting the contribution of prenatal factors to cardiovascular risk development. These findings extend current knowledge within the Developmental Origins of Health and Disease (DOHaD) framework by demonstrating interaction effects in childhood. Prenatal conditions may shape individual susceptibility to obesity-related increases in blood pressure. This study provides new insights that may contribute to pediatric cardiovascular risk assessment and early prevention strategies.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040243","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 Fluid Overload Ultrafiltration Percentage (FOUP): a novel metric that contextualizes fluid removal to initial burden in pediatric CRRT.","authors":"Dong Li, Xiaowei Xiong, Chunxiao Wang, Changyang Ye, Ke Bai, Chengjun Liu","doi":"10.1038/s41390-026-05469-4","DOIUrl":"https://doi.org/10.1038/s41390-026-05469-4","url":null,"abstract":"<p><strong>Background: </strong>Optimal fluid removal during pediatric continuous renal replacement therapy (CRRT) remains challenging. Conventional metrics-net ultrafiltration rate (NUFR) and net fluid balance (NFB)-do not assess removal efficiency relative to initial fluid overload (FO). We hypothesized Fluid Overload Ultrafiltration Percentage (FOUP)-cumulative NFB normalized to initial FO-would reveal clinically meaningful patterns.</p><p><strong>Methods: </strong>We studied 220 children receiving CRRT for ≥72 h. FOUP, NUFR, and NFB were calculated over three 24-h intervals. Subgroup analyses were performed within survivors stratified by FO (<5% vs. ≥5%), capillary leak index (CLI < 3.3 vs. ≥3.3), and body weight.</p><p><strong>Results: </strong>Non-survivors (n = 84) had higher baseline FO (6.6% vs. 2.4%, p < 0.001) and received higher NUFR at all time points (all p < 0.01), yet achieved similar NFB and FOUP. NUFR trajectories diverged: survivors decreased (p = 0.003), and non-survivors increased (p = 0.013). In survivors, FOUP revealed a biphasic pattern in high-risk patients (FO ≥ 5% or CLI ≥ 3.3): vigorous early removal (-43.3% at 24 h) followed by a plateau (-2.0% to -4.1% at 48-72 h, p< 0.001), despite continued high NUFR. Hemodynamic stability was maintained.</p><p><strong>Conclusions: </strong>FOUP normalizes fluid removal to the initial FO, revealing a biphasic pattern in high-risk patients-early rapid removal followed by a plateau, signaling diminishing returns. These findings support a response-adaptive, FOUP-guided approach.</p><p><strong>Impact: </strong>This study introduces FOUP, a metric normalizing fluid removal to initial overload. Unlike weight-dependent NUFR or absolute NFB-which require baseline FO for interpretation-FOUP directly quantifies removal relative to initial burden. This enables FOUP to reveal clinically meaningful patterns: in patients with FO ≥ 5% or CLI ≥ 3.3, FOUP shows a biphasic trajectory-vigorous early removal followed by a plateau at 48-72 h-indicating that continued high-intensity ultrafiltration yields diminishing returns. By contextualizing removal to initial overload, FOUP provides a rational basis for response-adaptive fluid management.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040272","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":"Infection prevention: neonatal European vascular access team - ESPR recommendation 8.","authors":"Brenda van Delft, Maria Grazia Romitti, Matheus van Rens, Agnes van den Hoogen, Suzy Van Eenoo, Fiammetta Piersigilli, Robin van der Lee, Tom Ouwehand, Kevin Hugill","doi":"10.1038/s41390-026-05464-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05464-9","url":null,"abstract":"<p><strong>Impact: </strong>Strategies to prevent infection are key in safe neonatal vascular access. This recommendation outlines infection prevention strategies throughout the vascular access lifecycle, from insertion through maintenance to discontinuation. It incorporates international guidance and NICU-specific adaptations to reduce microbial burden. This recommendation incorporates international expert guidance and NICU-specific adaptations to reduce microbial burden. The importance of standardized protocols for assessment, insertion and evaluation is highlighted. As part of a Special Article Series these recommendations encompass the full process involved in neonatal vascular access.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040280","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 identification of Prader-Willi syndrome in newborns using facial phenotype-based machine learning.","authors":"Yunqian Zhu, Huihui Chen, Jieyi Chen, Lin Yang, Xinran Dong, Qi Ni, Wenhao Zhou","doi":"10.1038/s41390-026-05491-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05491-6","url":null,"abstract":"<p><strong>Background: </strong>Existing facial models for Prader-Willi syndrome (PWS) demonstrate limited accuracy in newborns with subtle facial dysmorphism.</p><p><strong>Methods: </strong>Photographs of children from a public platform (training cohort) and of newborns from Children's Hospital of Fudan University (validation cohort) were used for feature comparison. Models were developed using six algorithms with three feature sets (Complete-, Top-10, and ClinSel-) in the training cohort. Model performance, calibration, feature importance, and sensitivity analysis were assessed. External validation via threshold re-estimation was compared with Face2Gene.</p><p><strong>Results: </strong>Of 113 children (21 [19%] PWS), RF and AdaBoost gained the highest Area Under the Precision-Recall Curve across all feature sets. RF Complete-set model achieved highest sensitivity (mean [95% CI], 0.97 [0.84-1.00]) with 0.95 specificity (95% CI, 0.83-1.00) and was well calibrated. Age, face width, and upper lip-related features were important features. Four previously unreported features (jaw symmetry, chin, nose, and jaw widths) were identified. Sensitivity analysis showed 26 facial features contribute more than age. In external validation (10 PWS newborns and 13 controls), RF Complete-set model achieved comparable sensitivity (0.80 vs. 0.70) and significantly higher specificity (0.77 vs. 0.15) at a false positive rate ≤0.25 compared with Face2Gene.</p><p><strong>Conclusions: </strong>RF Complete-set model demonstrates potential for neonatal PWS identification.</p><p><strong>Impact: </strong>Facial phenotype-based machine learning models for identifying Prader-Willi syndrome (PWS) in newborns facilitate early detection of PWS before genetic testing. Models achieved comparable sensitivity but higher specificity than Face2Gene, providing a favorable tool for PWS. Four previously unreported facial features-jaw symmetry, chin, nose, and jaw widths-expand the PWS facial phenotype. Models trained on children successfully identified PWS newborns after threshold adjustment, showing the value of reusing pediatric data when newborn samples are limited. Pilot validation in newborns with 0.80 sensitivity and 0.77 specificity supports the feasibility of machine learning-based screening for genetic syndromes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031277","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":"Neonatal vascular access: management of pain and distress during vascular access device placement.","authors":"Tobias Werther, Mónica Marçal, Madalena Lopo Tuna, Anabela Salazar, Robin van der Lee, Paola Lago, Silke Mader, Fiammetta Piersigilli, Suzy Van Eenoo, Kevin Hugill, Matheus van Rens","doi":"10.1038/s41390-026-05482-7","DOIUrl":"https://doi.org/10.1038/s41390-026-05482-7","url":null,"abstract":"<p><strong>Impact: </strong>Vascular access is a pervasive facet of contemporary neonatal practice, yet it lacks standardization, and some practices lack supporting evidence. The purpose of this recommendation is to support healthcare providers to assess, manage, and alleviate pain and distress associated with vascular access device (VAD) placement in neonates.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031293","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":"Airway management and postoperative respiratory recovery after intravitreal injection in preterm infants.","authors":"Ying Chen, Yijing Cheng, Fuxia Yan, Shoudong Pan, Ding Han","doi":"10.1038/s41390-026-05512-4","DOIUrl":"https://doi.org/10.1038/s41390-026-05512-4","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants undergoing intravitreal ranibizumab injection for retinopathy of prematurity are vulnerable to perioperative respiratory instability. Whether airway strategy is associated with postoperative respiratory recovery remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study of 134 preterm infants undergoing intravitreal ranibizumab injection under general anesthesia. Infants were managed with a laryngeal mask airway (LMA, n = 83) or endotracheal intubation (ETI, n = 51). The primary outcome was respiratory support escalation within 24 hours. The primary analysis used inverse probability of treatment weighting.</p><p><strong>Results: </strong>Respiratory support escalation occurred in 6/83 (7.2%) infants in the LMA group and 20/51 (39.2%) in the ETI group. In the weighted analysis, LMA use was associated with a lower risk than ETI (RR 0.36, 95% CI 0.15-0.88; P = 0.026). In unadjusted secondary analyses, the LMA group was more likely to return to baseline support by 24 hours (90.4% versus 66.7%, P = 0.012) and less likely to require unplanned reintubation (1.2% versus 9.8%, P = 0.044).</p><p><strong>Conclusion: </strong>In selected preterm infants undergoing intravitreal injection under general anesthesia in the operating room, LMA use was associated with better early postoperative respiratory recovery than ETI. The findings may apply when LMA placement is technically feasible and clinically appropriate.</p><p><strong>Impact: </strong>In preterm infants undergoing intravitreal injection under general anesthesia in the operating room, laryngeal mask airway use was associated with a lower risk of respiratory support escalation within 24 hours than endotracheal intubation. Using inverse probability of treatment weighting to address measured baseline differences, this study provides a confounding-adjusted estimate and extends observations from laser photocoagulation to the briefer setting of intravitreal injection. The findings are associative and hypothesis-generating and may inform airway-device selection when laryngeal mask placement is technically feasible and clinically considered an appropriate airway option. Prospective multicenter studies are warranted.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031255","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":"Distinct clinical patterns of preterm infants vulnerable to intestinal injury identified by unsupervised clustering.","authors":"Seong Hee Oh, Yong-Sung Choi, Sung-Hoon Chung, Jehyeuk Ahn, Ji Yoo Kim, Eun Hye Lee, Nima Aghaeepour, David Stevenson, Josef Neu","doi":"10.1038/s41390-026-05494-3","DOIUrl":"https://doi.org/10.1038/s41390-026-05494-3","url":null,"abstract":"<p><strong>Background: </strong>Current necrotizing enterocolitis (NEC) diagnostic criteria fail to capture the full spectrum of intestinal injury. We aimed to identify diagnosis-independent clinical patterns of intestinal injury among vulnerable very low birth weight (VLBW) infants using unsupervised hierarchical clustering.</p><p><strong>Methods: </strong>Using prospectively collected data from 20,352 VLBW infants in the Korean Neonatal Network (2013-2022), unsupervised clustering was performed after excluding variables reflecting prematurity and NEC diagnosis.</p><p><strong>Results: </strong>Eight primary clusters (C1-C8) were identified from the dataset without NEC-related labels. Cluster 8, which exhibited the highest prevalence of previously diagnosed NEC ≥ stage 2, was subdivided into five distinct clinical subclusters (SC23-SC27) based on feature importance: antenatal antibiotic exposure (SC23), assisted reproduction (SC24), pregnancy-induced hypertension (SC25), chorioamnionitis/PPROM (SC26), and severe postnatal morbidities (SC27). In terms of hierarchical structure validation, survival patterns across clusters showed strong concordance between Kaplan-Meier estimates and supervised survival model predictions.</p><p><strong>Conclusion: </strong>Unsupervised clustering successfully identified distinct clinical features among preterm infants vulnerable to intestinal injury, independent of traditional diagnostic labels. These nuanced clusters provide a valuable framework for developing a novel, more comprehensive taxonomy of intestinal injuries in this high-risk population.</p><p><strong>Impact: </strong>The newly proposed framework of intestinal injury in very low birth weight infants comprises clinically distinct phenotypes that are not adequately captured by diagnosis-based NEC classification. Using unsupervised hierarchical clustering in a large multicenter cohort, this study identifies diagnosis-independent phenotypic structure underlying neonatal intestinal injury. These findings reinforce the heterogeneity of intestinal injuries. They provide more nuanced clusters derived using unsupervised machine learning from a large database of patients and provide a framework for the development of more precise taxonomies in preterm infants that obviate the need for the misnomer currently termed NEC.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025629","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}