Pediatric Research最新文献

{"title":"Editor’s Focus","authors":"","doi":"10.1038/s41390-025-04338-w","DOIUrl":"10.1038/s41390-025-04338-w","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":"98 2","pages":"343-343"},"PeriodicalIF":3.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111433","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":"Pyloric index: a novel nomogram predictor of metabolic alkalosis in congenital hypertrophic pyloric stenosis.","authors":"Yongcheng Fu, Jian Cheng, Xing Zhou, Xiaohan Qin, Jingyue Wang, Yuanyuan Wang, Shangkun Li, Juan Ding, Da Zhang","doi":"10.1038/s41390-025-04382-6","DOIUrl":"https://doi.org/10.1038/s41390-025-04382-6","url":null,"abstract":"<p><strong>Background: </strong>Metabolic alkalosis (MA) is a common complication of congenital hypertrophic pyloric stenosis (CHPS). This study develops and validates a nomogram to predict MA probability in CHPS infants.</p><p><strong>Methods: </strong>A retrospective study was conducted on CHPS patients at the First Affiliated Hospital of Zhengzhou University. Patients were divided into CHPS and MA-CHPS groups. Lasso and logistic regression selected predictive factors, and a nomogram was developed. Discriminative ability was assessed using the C-index with bootstrap validation. Calibration curves evaluated predictive accuracy, while decision curve analysis (DCA) assessed clinical applicability.</p><p><strong>Results: </strong>A total of 107 cases were included in the final analysis, with 81 in the CHPS group and 26 in the MA-CHPS group. The predictive nomogram included the following factors: weight at diagnosis, symptom duration, and pyloric index (PI). The C-index of the predictive nomogram was determined to be 0.818, with a bootstrap validation (1000 resamples) yielding a corrected C-index of 0.798, indicating good discriminative ability. Calibration curves demonstrated a high degree of consistency between predicted and actual results. DCA confirmed good clinical utility.</p><p><strong>Conclusion: </strong>We developed a nomogram to predict the probability of MA in CHPS patients, enabling early identification of poor prognosis and improving outcomes.</p><p><strong>Impact statement: </strong>This study presents a novel predictive model for assessing the probability of metabolic alkalosis (MA) in congenital hypertrophic pyloric stenosis (CHPS) infants. It is the first model integrating the pyloric index (PI) as a predictive factor, alongside weight at diagnosis and symptom duration. The nomogram demonstrated strong discriminative ability and clinical utility, aiding early MA identification and improving perioperative management. By providing a practical risk stratification tool, this model enhances clinical decision-making, facilitates timely interventions, and ultimately improves outcomes for CHPS infants.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125572","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":"Legal, clinical, and scientific perspectives on formula use and NEC risk in preterm infants.","authors":"Parvesh Mohan Garg, Ricardo J Rodriguez, Jeffrey S Shenberger","doi":"10.1038/s41390-025-04438-7","DOIUrl":"10.1038/s41390-025-04438-7","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumulative caffeine exposure predicts neurodevelopmental outcomes in premature infants.","authors":"Bridget E L Ostrem, Elizabeth Odell, Kimberly N Grelli, Katelin Kramer, Natalie Chan, Fei Jiang, Duan Xu, A James Barkovich, Matthew J Barkovich, Donna M Ferriero, Dawn Gano","doi":"10.1038/s41390-025-04387-1","DOIUrl":"https://doi.org/10.1038/s41390-025-04387-1","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants who receive caffeine for apnea of prematurity have improved neurodevelopmental outcomes compared to untreated infants. The optimal dosing regimen for neuroprotection is unknown. We hypothesized that higher caffeine exposure is associated with improved neurodevelopmental performance.</p><p><strong>Methods: </strong>We quantified caffeine exposure in a previously reported cohort of 106 infants born at ≤32 gestational weeks who received brain MRIs during the neonatal hospitalization. Infants were subdivided into tertiles based on average daily caffeine exposure (ADCE). Bayley-III examinations were performed on 69 participants at 30 months corrected age. Neurodevelopmental impairment (NDI) was defined as a score of ≤85 on the Bayley-III motor, language, and/or cognitive subscales. We evaluated the relationship between caffeine exposure, neuroimaging abnormalities, and neurodevelopmental performance.</p><p><strong>Results: </strong>Higher ADCE was associated with decreased odds of NDI (OR 0.69, 95% C.I. 0.50-0.95) but not with MRI abnormalities. High dose caffeine was associated with improved motor (mean difference 10.9, 95% C.I. 0.7-21.0), language (mean difference 15.2, 95% C.I. 3.4-27.0), and cognitive (mean difference 13.0, 95% C.I. 0.6-25.4) performance compared to low dose in multivariable analyses adjusted for gestational age and respiratory disease.</p><p><strong>Conclusion: </strong>Higher sustained caffeine exposure during the neonatal hospitalization is associated with improved neurodevelopmental outcomes in preterm infants.</p><p><strong>Impact: </strong>Premature infants who receive caffeine for apnea of prematurity have improved neurodevelopmental outcomes compared to untreated infants. The optimal dosing strategy for neuroprotection is unknown. We found that higher average daily exposure during the neonatal hospitalization was associated with reduced neurodevelopmental impairment at 30 months corrected age. High dose caffeine was associated with improved motor, language, and cognitive performance on the Bayley-III compared to low dose caffeine in multivariable analyses adjusted for gestational age and respiratory disease. Preterm infants may benefit from higher maintenance doses and/or from continuing caffeine beyond the period of respiratory need.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102725","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":"Confirmatory-factor-analysis-derived metabolic syndrome risk score: development, validation, and clinical utility in dual adolescent populations.","authors":"Yu-Ting Chin, Pei-Wen Wu, Pin-Rui Huang, Sharon Tsai, Wei-Ting Lin, Chun-Ying Lee, Wei-Chung Tsai, Chien-Hung Lee","doi":"10.1038/s41390-025-04419-w","DOIUrl":"https://doi.org/10.1038/s41390-025-04419-w","url":null,"abstract":"<p><strong>Background: </strong>This study developed and validated a continuous metabolic syndrome (MetS) risk score (msRS) for adolescents and evaluated its clinical utility in identifying multiple clinical cardiovascular markers (CCMs) using dual adolescent populations.</p><p><strong>Methods: </strong>Adolescents aged 12‒18 from two stratified random samples were used: the nationwide Nutrition and Health Survey in Taiwan (NAHSIT, n = 1920) for development and the Adiposity‒Cardiovascular Disease Axis study in Southern Taiwan (adiCards, n = 3295) for validation. Four sex-and-age-specific msRS were developed through confirmatory factor analysis (CFA) utilizing five MetS components-waist circumference, high-density lipoprotein cholesterol, triglycerides, fasting glucose, and mean arterial pressure. Their discriminatory ability for clinical outcomes was validated using the area under receiver operating characteristic (AU-ROC) curve.</p><p><strong>Results: </strong>The msRS demonstrated exceptional capability in detecting MetS in NAHSIT and adiCards cohorts (AU-ROCs: 0.954‒0.969). Adjusted for covariates, msRS explained higher variability in body-fat percentage, apolipoproteins B/A1, and homeostatic model assessment of insulin resistance (HOMA-IR) than binary MetS and abnormal components count (partial R², 23.7‒26.8% vs 4.1‒20.7%) in the validation dataset. An increase in msRS was associated with a 1.9-, 2.7-, 3.4-, and 14.4-fold risk of elevated low-density lipoprotein cholesterol, hyperuricemia, high HOMA-IR, and ≥3 CCMs.</p><p><strong>Conclusion: </strong>The CFA-derived sex-and-age-adjusted msRS scheme provides an improving measure to assess and manage adolescent cardiometabolic health.</p><p><strong>Impact: </strong>Adolescent MetS components share a latent metabolic construct. A scoring system through confirmatory factor analysis captures sex-and-age specific metabolic heterogeneity. Continuous risk score accurately discriminates pediatric MetS. MetS risk score effectively detects pediatric cardiovascular risk. Consideration of population characteristics is essential when developing a continuous MetS score.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102687","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":"Bilirubin: translational perspectives.","authors":"Libor Vítek","doi":"10.1038/s41390-025-04432-z","DOIUrl":"https://doi.org/10.1038/s41390-025-04432-z","url":null,"abstract":"<p><p>Bilirubin, an old tetrapyrrolic compound that had occurred on Earth early on, is the final product of the catabolic heme pathway in the intravascular bed. Data from recent decades revealed its enormous bioactivity in a human body, including antioxidant, anti-inflammatory, immunosuppressive, antiproliferative, and even cell signaling activities that translate into beneficial effects of mildly elevated serum bilirubin concentrations resulting in prevention or amelioration of progression of many diseases of civilization. Furthermore, recent advances in bilirubin research have changed our understanding of bilirubin metabolism in the neonatal period, with discoveries of bilirubin reductase of bacterial origin in the intestinal lumen with direct pathophysiological and clinical implications. Similarly, our knowledge of the pathophysiology of neonatal jaundice phototherapy has improved substantially, although we are still at the beginning of the path to understand all the pathophysiological aspects and reveal related clinical implications. BULLET POINTS: Recent advances in our understanding of bilirubin metabolism with clear clinical implications, as well as other, so far putative, translational impacts. Demonstration of the beneficial biological potential of bilirubin, its evolutionary and ontogenetic functions, its possible role in chronobiology, and its correlation with increased fitness in elite athletes (a sort of gain of function). Discussion on the protective role of physiological neonatal jaundice. Inspiration for further basic and clinical research in specific fields of bilirubin metabolism.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092270","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":"Urine neutrophil gelatinase-associated lipocalin predicts kidney support therapy duration and liberation in critically ill children.","authors":"Giovanni Ceschia, Katja M Gist, Imogen Clover-Brown, Kelli A Krallman, Ana C Navarro, Stuart L Goldstein","doi":"10.1038/s41390-025-04430-1","DOIUrl":"https://doi.org/10.1038/s41390-025-04430-1","url":null,"abstract":"<p><strong>Background: </strong>Early identification of kidney recovery in critically ill children and young adults undergoing continuous kidney support therapy (CKST) is essential to optimize care and minimize complications. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker of acute kidney injury, but its utility in predicting CKST duration and guiding timely liberation remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed urinary uNGAL levels in pediatric intensive care unit (PICU) patients (aged 2 months to 25 years) who received CKST between July 2018 and April 2024. We evaluated two outcomes: (1) the ability of peak uNGAL levels during the first four days of CKST to predict prolonged therapy (>7 days), and (2) the performance of uNGAL measured during KST liberation attempts in predicting successful liberation.</p><p><strong>Results: </strong>Among 57 patients, early peak uNGAL predicted CKST duration >7 days with good accuracy (AUC-ROC 0.85 [95% CI, 0.73-0.97], optimal cutoff 2600 ng/mL). uNGAL also showed excellent performance in predicting successful KST liberation (AUC-ROC 0.95 [95% CI, 0.89-1.00], optimal cutoff 900 ng/mL).</p><p><strong>Conclusions: </strong>uNGAL may be useful for predicting prolonged CKST duration and guiding KST liberation in critically ill children. Larger prospective studies are needed to confirm its role in personalized CKST management.</p><p><strong>Impact statement: </strong>Peak uNGAL levels within the first four days of CKST are strongly associated with treatment duration >7 days, showing good predictive accuracy. uNGAL demonstrates excellent performance in identifying patients likely to achieve successful KST liberation. uNGAL measured during KST may support clinical decision-making by providing timing insights, potentially optimizing treatment duration in critically ill pediatric patients.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091580","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":"Histologic chorioamnionitis and fat mass accretion in infants born preterm.","authors":"Emily Gunawan, Viral G Jain, Shakia Hardy, M Ryan Irvin, Ariel A Salas","doi":"10.1038/s41390-025-04413-2","DOIUrl":"https://doi.org/10.1038/s41390-025-04413-2","url":null,"abstract":"<p><strong>Background: </strong>In utero insults such as chorioamnionitis are associated with adverse outcomes. This study aims to examine the association between chorioamnionitis and fat mass (FM) in very preterm infants.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of mother-infant dyads born <32^6/7 weeks of gestation. Infant FM accretion was measured using air displacement plethysmography at term-equivalent age. Histological chorioamnionitis severity was staged based on placental pathology and included maternal/chorion-amnion inflammatory response (MIR) and fetal/umbilical cord inflammatory response (FIR). The association between chorioamnionitis severity and FM accretion was analyzed using linear regression models and mediation analyses.</p><p><strong>Results: </strong>Among 375 mother-infant dyads analyzed, 104 (28%) dyads had MIR. FIR was found in 85 dyads with MIR (82%). Infants without MIR had lower FM in Kg and lower FM z scores than those with MIR (p = 0.0001). Infants with severe MIR had higher body fat percentages (Stage 3: 18% vs Stage 1: 14%, p < 0.0001). There were no significant differences in other anthropometric growth rates. Gestational age partially mediated this association (49%).</p><p><strong>Conclusion: </strong>Severe histological chorioamnionitis is associated with greater FM accretion at term-equivalent age, independent of gestational age. Without long-term data, it remains unclear whether this early-onset effect is transient or persists into later childhood.</p><p><strong>Impact statement: </strong>Chorioamnionitis is common in infants born preterm and is strongly associated with preterm birth. Infants born preterm exposed to chorioamnionitis have an increased risk of abnormal fat mass accretion at term equivalent age. Accounting for the severity of chorioamnionitis could improve the interpretation of body fat accretion in infants born preterm.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092251","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":"Betaine improves hyperoxic lung injury through downregulating pulmonary macrophage pyroptosis in newborn mice.","authors":"Jufeng Zhang, Lin Zhou, Hui Xu, You You, Siyi Xia, Hongping Xia","doi":"10.1038/s41390-025-04364-8","DOIUrl":"https://doi.org/10.1038/s41390-025-04364-8","url":null,"abstract":"<p><strong>Background: </strong>Bronchopulmonary dysplasia (BPD) is a common chronic respiratory disease in preterm infants. NLRP3-mediated macrophage pyroptosis plays a crucial role in the pathogenesis of BPD. Recent evidence suggests that betaine has anti-inflammatory and antioxidant functions. This study aimed to investigate the effect of betaine on pulmonary macrophage pyroptosis in BPD.</p><p><strong>Methods: </strong>Newborn mice were exposed to either hyperoxia (90%) or room air shortly after birth and treated subcutaneously with betaine daily for 14 days. Lung development, the expression of macrophage pyrolysis-associated proteins and the phospho-forkhead box O1 (p-FOXO1) were evaluated. In vitro, the effect of betaine on the expression of p-FOXO1 was assessed in RAW264.7 macrophages exposed to either 90% oxygen or 21% oxygen, with okadaic acid (OA) as phosphatase inhibitor.</p><p><strong>Results: </strong>Hyperoxia induced macrophage pyroptosis and impaired lung development in newborn mice. Betaine inhibited p-FOXO1 expression and NLRP3-mediated pyroptosis in pulmonary and promoted lung development in the hyperoxia-exposed mice. In vitro, betaine suppressed FOXO1 phosphorylation and NLRP3-mediated pyroptosis under 90% oxygen in RAW264.7 cells, and OA administration reversed these effects.</p><p><strong>Conclusion: </strong>Betaine may reduce the expression of inflammatory cytokines, downregulate macrophage pyroptosis by inhibiting the phosphorylation of FOXO1, and improve lung development in BPD.</p><p><strong>Impact: </strong>Our previous research showed that plasma betaine levels at 36 weeks postmenstrual age (PMA) were significantly lower in preterm infants with BPD compared to those without BPD. Betaine has anti-inflammatory and antioxidant functions. However, its role in pulmonary macrophage pyroptosis in BPD remains unknown. The study shows that betaine may downregulate macrophage pyroptosis by inhibiting FOXO1 phosphorylation, alleviate lung inflammation, and improve lung development in BPD.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092241","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":"Animal intelligence (the original AI): what Winston teaches me about patient care.","authors":"Andrew M Fine","doi":"10.1038/s41390-025-04394-2","DOIUrl":"https://doi.org/10.1038/s41390-025-04394-2","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092238","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}