Pediatric Research最新文献

{"title":"Management of peripheral venous access devices (PVADs): Neonatal European Vascular Access Team - ESPR Recommendation 5.","authors":"Matheus van Rens, Robin van der Lee, Agnes van den Hoogen, Carmen Rodriguez-Perez, Fiammetta Piersigilli, Silke Mader, Isabel Geiger, Giovanni Barone, Suzy Van Eenoo, Kevin Hugill","doi":"10.1038/s41390-026-05515-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05515-1","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. This recommendation introduces a structured, evidence-based approach to neonatal peripheral venous access, addressing longstanding challenges such as high failure rates and inconsistent clinical practices. Its novelty lies in integrating advanced visualization tools, standardized assessment protocols (RaSuVA, TLC), and modern securement strategies to optimize catheter longevity and safety. By shifting from habit-driven decisions to individualized vascular access planning, it sets a new standard for safer, more effective neonatal IV therapy.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025631","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":"Food for thought: a mixed methods analysis of nutrition decision making during bedside rounds in the neonatal intensive care unit.","authors":"Gustave H Falciglia, Irem Sengul Orgut, Karna Murthy, Karen Smilowitz, Daniel T Robinson, Julie K Johnson","doi":"10.1038/s41390-026-05502-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05502-6","url":null,"abstract":"<p><strong>Background: </strong>Variation in nutrition delivery contributes to poor growth in preterm infants in the neonatal intensive care unit (NICU); however, few studies have examined how clinicians develop nutrition plans. The aim of this research is to describe the nutrition decision-making process during rounds for preterm infants in the NICU.</p><p><strong>Methods: </strong>We conducted a convergent parallel mixed methods study of bedside rounds on preterm infants at two NICUs. Qualitative data were collected by observing rounds which were recorded, transcribed, and analyzed thematically. Quantitative data were abstracted from the medical record. Data were merged to analyze characteristics of discussion of infant nutrition.</p><p><strong>Results: </strong>Four nutrition-specific themes characterized discussion during rounds for preterm infants: 1) nutrition is important but fluid is prioritized, and discussion of nutrition occurs in the language of fluid; 2) discussions reflect uncertainty and lack specificity; 3) fluid allowance, feeding tolerance, growth and metabolism are primary drivers of nutrition plans; and 4) distinguishing whether measured weights indicate growth versus fluid retention or measurement error is challenging.</p><p><strong>Conclusion: </strong>Multiple direct and indirect drivers influence nutrition decisions. Clinicians answer questions about nutrition by discussing fluid. This may lead to suboptimal solutions during the transition phase of nutrition and periods of fluid restriction.</p><p><strong>Impact: </strong>In the neonatal intensive care unit, nutrition-specific concerns of fluid allowance, feeding intolerance, growth and metabolism are drivers of the nutrition decision-making process for infants and involve several tradeoffs. Rather than discussing \"how much nutrition the baby received,\" clinicians commonly used a heuristic to more easily approximate energy or protein intake by discussing \"how much fluid the baby received.\" Distinguishing actual growth from measurement error and fluid retention is challenging. Clinicians lack easily accessible data to accurately assess what nutrition the infant received and how the infant grew in response.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017477","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":"Insertion and management of intraosseous devices: Neonatal European Vascular Access Team - ESPR Recommendation 9.","authors":"Bernhard Schwaberger, Anna Milan, Robin van der Lee, Fiammetta Piersigilli, Tom Ouwehand, Suzy Van Eenoo, Kevin Hugill, Matheus van Rens","doi":"10.1038/s41390-026-05475-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05475-6","url":null,"abstract":"<p><strong>Impact: </strong>This recommendation is important as it addresses the urgent need for reliable vascular access in life-threatening neonatal emergencies when conventional methods fail. Its novelty lies in consolidating existing evidence, anatomical data, and device-specific considerations into a comprehensive, neonatal-focused guide for safe intraosseous (IO) access. By promoting standardized training, risk-based site selection, and careful technique, it has the potential to improve emergency care, reduce complications, and save lives in critically ill neonates.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025601","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":"Paracetamol and the developing lung: how much evidence is enough?","authors":"Sergio Verd, Silvia Boo, Juan-Antonio Costa-Orvay","doi":"10.1038/s41390-026-05532-0","DOIUrl":"https://doi.org/10.1038/s41390-026-05532-0","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017449","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":"Bringing work home: the microbiota of children of healthcare workers.","authors":"Luca Ferrari, Marco Severgnini, Marco Cugliari, Chiara Favero, Marco Alberzoni, Gregorio P Milani","doi":"10.1038/s41390-026-05474-7","DOIUrl":"https://doi.org/10.1038/s41390-026-05474-7","url":null,"abstract":"<p><strong>Impact: </strong>Children of healthcare workers have a lower nasal microbiota diversity in early life compared with children of non-healthcare workers, with more pronounced differences when both parents work in healthcare. This study links parental healthcare occupation with differences in nasal microbiota of children, identifying occupational household exposure as a factor potentially influencing microbial colonization. The study highlights parental occupation as an underrecognized environmental determinant of early-life microbiota, providing bases for future research on occupational exposures and child respiratory and immune health.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017502","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":"Shielding the fetal brain: maternal vitamin D attenuates the neurodevelopmental consequences of gestational diabetes mellitus.","authors":"Ali H Ziyab","doi":"10.1038/s41390-026-05522-2","DOIUrl":"https://doi.org/10.1038/s41390-026-05522-2","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017439","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":"Risk of apnoea-related cardiorespiratory instability in preterm infants is modulated by clinical, demographic and dynamic indicators.","authors":"Yiru Chen, Vithushanan Ketheeswaranathan, Surina Fordington, Luke Baxter, Freya Stevens, Coen S Zandvoort, Rose Gawthorpe, Mauricio Villarroel, Luc Berthouze, Caroline Hartley","doi":"10.1038/s41390-026-05434-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05434-1","url":null,"abstract":"<p><strong>Background: </strong>Apnoea of prematurity is common and may cause desaturation and/or bradycardia. There is marked variability in infants' cardiorespiratory responses to apnoea, despite standardised clinical thresholds. Factors influencing apnoea-related cardiorespiratory instability and whether instability can be predicted warrant investigation.</p><p><strong>Methods: </strong>181,511 apnoeas >5 s were identified from 146 preterm infants <37 weeks' postmenstrual age. Cardiorespiratory instability was defined as bradycardia (>30% heart rate reduction) and/or oxygen desaturation (<85%). Mixed-effects models assessed clinical, demographic and dynamic modulators of the relationship between apnoea duration and cardiorespiratory instability. Machine learning (XGBoost) was used to train models to predict apnoea-related cardiorespiratory instability.</p><p><strong>Results: </strong>Longer duration apnoeas were associated with increased instability, although variability was substantial and 3.6% of apnoeas <10 s were associated with cardiorespiratory instability, while 61.2% of apnoeas ≥20 s were not. Multiple clinical/demographic (postmenstrual and gestational age, sex, weight z-score, ventilation mode) and dynamic (baseline heart rate, oxygen saturation, recent apnoea clustering) factors were associated with increased instability risk. Apnoea-related cardiorespiratory instability could be predicted with a balanced test accuracy of 75.8% when incorporating all features, and 66.0% using only clinical/demographic features.</p><p><strong>Conclusions: </strong>Multiple factors influence cardiorespiratory responses to apnoea. Predictive modelling may enable personalised apnoea definitions, improving individualised care.</p><p><strong>Impact: </strong>We investigated variability in cardiorespiratory instability following apnoea in preterm infants. We demonstrate multiple factors which influence the cardiorespiratory changes following apnoea and develop a machine learning model which can accurately predict apnoea-related cardiorespiratory instability. Prediction of cardiorespiratory instability could enable personalised apnoea alarms and inform discharge and treatment decision making.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008866","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 body mass index trajectories throughout childhood in girls with early puberty.","authors":"Grith Laerkholm, Pernille Falberg Rønn, David Horner, Rasmus Wibaek, Rikke Beck Jensen","doi":"10.1038/s41390-026-05505-3","DOIUrl":"https://doi.org/10.1038/s41390-026-05505-3","url":null,"abstract":"<p><strong>Background: </strong>Early pubertal development in girls has been associated with increased adiposity in childhood. However, longitudinal body mass index (BMI) trajectories preceding the diagnosis of precocious puberty (PP) or premature adrenarche (PA) are less well described. We hypothesized that distinct BMI trajectories leading to overweight or obesity could be identified already in infancy and early childhood in these girls.</p><p><strong>Methods: </strong>In this nationwide register-based study, longitudinal data from Danish health registries were used to examine BMI trajectories from birth to 10 years of age. Girls diagnosed with PP or PA were analyzed separately using latent class trajectory analysis.</p><p><strong>Results: </strong>In both populations with either PP or PA, mean BMI levels were in the upper normal range from infancy, followed by early adiposity rebound and progression into the overweight range from mid-childhood. Three distinct BMI trajectory classes were identified in girls with PP and PA, characterized by persistently higher BMI, early adiposity rebound, or lower birth weight followed by rapid postnatal weight gain.</p><p><strong>Conclusions: </strong>Longitudinal BMI trajectories preceding the diagnosis of PP and PA showed heterogeneity in early-life growth patterns. These findings provide additional context for understanding how early-life adiposity and weight gain relate to pubertal timing and progression in girls.</p><p><strong>Impact: </strong>Girls with precocious puberty or premature adrenarche exhibit distinct BMI trajectories from infancy throughout childhood, characterized by early adiposity rebound and accelerated weight gain preceding pubertal onset. This study adds a longitudinal perspective by identifying heterogeneous early-life BMI trajectories, demonstrating that differences in growth patterns can be detected already in early childhood, rather than relying on single BMI measurements later in childhood. These findings highlight early childhood as a critical window during which modifiable growth patterns may influence pubertal timing and progression, with implications for early identification and prevention strategies.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008861","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":"Ultrasound-guided central vascular access and device tunneling: neonatal European vascular access team-ESPR recommendation 4.","authors":"Christian Breschan, Mauro Pittiruti, Robin van der Lee, Ignacio Oulego-Erroz, Tobias Werther, Fiammetta Piersigilli, Giovanni Barone, Tom Ouwehand, Suzy Van Eenoo, Kevin Hugill, Matheus van Rens","doi":"10.1038/s41390-026-05463-w","DOIUrl":"https://doi.org/10.1038/s41390-026-05463-w","url":null,"abstract":"<p><strong>Impact: </strong>The essential role of ultrasound in the various phases of insertion and evaluation of CICC and FICC is emphasized. The importance of standardized protocols for assessment, insertion and evaluation is highlighted. Implementation of this recommendation improves patient safety and reduces practice variation.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008804","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":"Exit site management: neonatal european vascular access team - ESPR recommendation 7.","authors":"Fiammetta Piersigilli, Maria Grazia Romitti, Suzy Van Eenoo, Robin van der Lee, Kevin Hugill, Matheus van Rens, Giulia Iacona, Giovanni Barone, Carmen Rodriguez-Perez","doi":"10.1038/s41390-026-05471-w","DOIUrl":"https://doi.org/10.1038/s41390-026-05471-w","url":null,"abstract":"<p><strong>Introduction: </strong>Neonatal skin immaturity, increased transepidermal water loss, prolonged catheter dwell times, and repeated dressing manipulation expose neonates to a high risk of catheter-related infection, skin injury, dressing failure, and device dislodgement. Standardized exit site management is therefore a fundamental component of neonatal vascular access care. This article is part of a special series of ten recommendations for the management of neonatal vascular access, developed through a structured multidisciplinary consensus process integrating literature appraisal and expert deliberation.</p><p><strong>Methods and clinical application: </strong>This recommendation provides evidence-based guidance for the management of exit sites of peripheral venous access devices, central venous access devices, and intra-arterial catheters in neonates. Key components include standardized assessment of the exit site and skin condition, risk-based application of Standard-ANTT® or Surgical-ANTT®, skin antisepsis adapted to gestational age, use of chlorhexidine-based solutions, securement with sutureless devices, application of octyl-butyl-cyanoacrylate glue, and use of semipermeable transparent dressings with high moisture vapor transmission rate (MVTR). Recommendations for dressing changes, complication monitoring, and catheter removal are also provided.</p><p><strong>Conclusion: </strong>Standardized exit site management may reduce catheter-related infections, medical adhesive-related skin injury, dressing failure, and device dislodgement, while improving consistency of care and patient safety across neonatal units.</p><p><strong>Impact: </strong>This recommendation provides evidence-based strategies for neonatal vascular access exit site management, including dressing selection, antisepsis, securement, and skin protection. Standardized exit site care may reduce catheter-related infections, dressing failure, skin injury, and device dislodgement in neonates. The recommendation promotes consistent use of aseptic non-touch technique (ANTT®), securement systems, and high MVTR dressings to preserve skin integrity and improve catheter stability. Implementing standardized exit site management practices enhances patient safety and reduces practice variation across neonatal centers.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008786","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}