Journal of Pediatrics最新文献

{"title":"Retinopathy of Prematurity and Risk of Structural Brain Abnormalities on MRI at Term among Infants Born at ≤32 Weeks of Gestation.","authors":"Shalini Roy, Laura Peterson, Beth Kline-Fath, Nehal A Parikh","doi":"10.1016/j.jpeds.2025.114711","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114711","url":null,"abstract":"<p><strong>Objective: </strong>To determine if retinopathy of prematurity (ROP) is associated with brain abnormalities on structural MRI at term-equivalent age in infants born preterm.</p><p><strong>Study design: </strong>We prospectively recruited 395 infants born preterm born at ≤ 32 weeks of gestation from five regional Cincinnati neonatal intensive care units. Eligible infants underwent routine ROP screening and diagnosis per international screening guidelines at 31 weeks postmenstrual age (PMA) or 5 to 6 weeks of age (whichever came later). We obtained non-sedated structural MRI at 39 to 44 weeks postmenstrual age. Brain injury/maturational abnormality was quantified using the validated Kidokoro global brain abnormality score by a single neuroradiologist. We performed multiple linear regression to determine the association between ROP and brain abnormality score while adjusting for several known confounders.</p><p><strong>Results: </strong>Of the regional sample of 395 infants born preterm, 134 (33.9%) developed ROP. Among those infants with ROP, 19 (14.2%) developed severe ROP (stage 3 or requiring treatment). In multiple linear regression analyses, ROP (any severity) (β= 1.5 [95% CI: 0.3, 2.8]) and severe ROP (β=2.3 [0.1, 4.5]) remained significantly associated with global brain abnormality score, independent of multiple confounders. In secondary analyses, ROP was significantly associated with cerebellar and deep nuclear gray matter but not white matter or cortical gray matter abnormalities.</p><p><strong>Conclusions: </strong>In our regional cohort of infants born preterm, ROP, especially severe ROP, was significantly associated with global brain abnormalities at term. Such abnormalities are likely the structural correlates of later functional visual and neurodevelopmental impairments commonly attributed to ROP diagnosis.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114711"},"PeriodicalIF":3.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Count of Neonatal Morbidities Predicts Outcomes at Age 10 and 15 in Infants Born Extremely Preterm.","authors":"Ruben Vaidya, Joe X Yi, T Michael O'Shea, Elizabeth T Jensen, Robert M Joseph, Jeffrey S Shenberger, Kartikeya Makker, Diana Yanni, Jean A Frazier, Rebecca Fry, Michael Msall, Semsa Gogcu, Rachana Singh","doi":"10.1016/j.jpeds.2025.114709","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114709","url":null,"abstract":"<p><strong>Objective: </strong>To assess if a simple count of 5 common neonatal morbidities, including bronchopulmonary dysplasia (BPD), ultrasound-identified severe brain injury (SBI), severe retinopathy of prematurity (ROP), surgical necrotizing enterocolitis (NEC) and sepsis, predict long-term neurocognitive impairment, general medical health, behavioral health, or quality of life (QOL) at age 10 and 15 years in children born extremely preterm.</p><p><strong>Study design: </strong>Participants from the multicenter, prospective, longitudinal study Extremely Low Gestational Age Newborns (ELGANs) were followed at ages 10 and 15 and were categorized into groups with 0, 1, 2, or ≥3 neonatal morbidities (BPD, SBI, ROP, NEC or sepsis). Long-term neurocognitive outcomes were assessed using latent profiles generated from standardized tests of intelligence and executive function. General medical health, behavioral health, and QOL were assessed using standardized assessments.</p><p><strong>Results: </strong>Of 1198 participants who survived to age 10,889 (74.2%) and 694 (57.9%) were evaluated at age 10 and 15 respectively. The number of neonatal morbidities was linearly related to the probability for moderate to severe neurocognitive impairment at age 10 and 15, and the probability of motor impairment, legal blindness, severe hearing loss, number of health disorders, ≥2 health disorders, and poor QOL at age 10.</p><p><strong>Conclusion: </strong>Among newborns born extremely preterm who survive long-term, a simple count of neonatal morbidities (including BPD, SBI, ROP, NEC, or sepsis) is linearly related to neurocognitive impairment, poor general health, and quality of life.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114709"},"PeriodicalIF":3.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation Fidelity of a Smartphone Application for Population-Based General Movement Assessment: the Early Moves Study.","authors":"Caroline F Alexander, Sarah E Hall, Alison Salt, Alicia Spittle, Catherine Morgan, Tiffany Grisbrook, Alishum Ali, Natasha Amery, Sue-Anne Davidson, Ashleigh Thornton, Mary Sharp, Emily Young, Robert S Ware, Desiree Silva, Roslyn Ward, Nadia Badawi, Samudragupta Bora, Roslyn N Boyd, Susan Woolfenden, Catherine Elliott, Jane Valentine","doi":"10.1016/j.jpeds.2025.114710","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114710","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the infant and maternal characteristics of the Early Moves cohort and to assess representativeness to the general population, and to evaluate the implementation fidelity of an application-based collection of General Movement Assessment (GMA) videos at writhing and fidgety age.</p><p><strong>Study design: </strong>Prospective observational study. Mothers who had recently delivered or were enrolled to deliver at maternity hospitals in Perth, Western Australia, were recruited from November 2019 to December 2023. Sociodemographic and infant clinical characteristics were extracted from hospital records. Parents were invited to record GMA videos using the Baby Moves smartphone app, which were assessed for scorability by certified GM assessors.</p><p><strong>Results: </strong>3,002 infants (mean gestation, 38.9 ± 1.7 weeks; 46.6% female) were recruited. Infants were representative of the local population with respect to key infant risk factors, although mothers were more likely to be Caucasian and reside in higher socioeconomic suburbs compared with Perth metropolitan births. Overall adherence was 76%, with 2,272 families returning at least one scorable GMA video, with the majority (>69%) requiring personalized reminders to upload. Risk factors for nonengagement were infant prematurity, special care nursery stay, low maternal age, low socioeconomic status, minority ethnicity, and single caregiver mothers.</p><p><strong>Conclusions: </strong>Inclusive recruitment strategies and broad inclusion criteria supported participation from diverse sociodemographic groups and infants representative of the local population on key medical risk factors. Parent-recorded GMA can be implemented in a large population-based cohort, though app-based notifications alone may be insufficient to facilitate engagement. Population-based applications should ensure targeted implementation strategies to support priority families.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114710"},"PeriodicalIF":3.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchopulmonary Dysplasia in Asian American, Native Hawaiian, and Pacific Islander Infants with Very Low Birth Weight in California.","authors":"Kalen Hendra, Xin Cui, Elliot Main, Henry C Lee, Scarlett Lin Gomez, Salma Shariff-Marco, Erik A Jensen, Jochen Profit","doi":"10.1016/j.jpeds.2025.114706","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114706","url":null,"abstract":"<p><strong>Objective: </strong>To characterize incidences of bronchopulmonary dysplasia (BPD) and oxygen use at discharge in infants with very low birth weight (VLBW) by Asian American, Native Hawaiian, and Pacific Islander (AANHPI) ethnicity.</p><p><strong>Study design: </strong>We studied infants with VLBW born in California from 2012-2019. Infants of AANHPI mothers were studied in aggregate, were disaggregated by maternal ethnicity, and were compared with infants of Black, Hispanic, and Non-Hispanic White (NHW) mothers. BPD was defined as the use of supplemental oxygen at 36 weeks postmenstrual age. Multivariable generalized estimating equation Poisson regression models adjusting for infant, maternal, and hospital-level factors compared outcomes across racial and ethnic groups using NHW as the reference.</p><p><strong>Results: </strong>We studied 29,467 infants whose mothers self-identified as AANHPI (n=5,002), Black (n=3,711), Hispanic (n=14,168), and NHW (n=6,586). In infants of AANHPI mothers, incidences of BPD and oxygen use at discharge were 24.9% (disaggregated range: 16.9%-30.5%) and 9.2% (disaggregated range: 5.8%-14.5%), respectively. Compared with infants of NHW mothers, infants of Asian Indian mothers had a significantly lower risk of BPD (adjusted relative risk [aRR] 0.71) and oxygen use at discharge (aRR 0.66), whereas infants of Chinese and Korean mothers had a significantly higher risk of BPD (aRR 1.28 and aRR 1.45, respectively) and oxygen use at discharge (aRR 1.46 and aRR 1.77, respectively).</p><p><strong>Conclusions: </strong>AANHPI data disaggregation demonstrated variability in incidences of BPD and oxygen use at discharge, and variability in risk compared with infants of NHW mothers. Our study highlights disparities across this diverse group that is typically studied in aggregate.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114706"},"PeriodicalIF":3.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pathway for Integrating Artificial Intelligence for Neonatal Neuromonitoring: From Code to Bedside.","authors":"Pawel Kulakowski, Ana Alarcón, Tamara Skoric, Silvia Seoni, Mark O'Sullivan, John M O'Toole","doi":"10.1016/j.jpeds.2025.114708","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114708","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114708"},"PeriodicalIF":3.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purtscher-Like Retinopathy Associated with Acute Pancreatitis in a Child.","authors":"Shobhit Shakya, Durga Prasad, Abhai Verma","doi":"10.1016/j.jpeds.2025.114707","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114707","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114707"},"PeriodicalIF":3.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Prevalence and Clinical Significance of Autoantibodies in Children with Overweight and Obesity with Nonalcoholic Fatty Liver Disease\" [The Journal of Pediatrics volume 239 (2021) P155 - 160].","authors":"Ammar Khayat, Bernadette Vitola","doi":"10.1016/j.jpeds.2025.114677","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114677","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114677"},"PeriodicalIF":3.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microaggressions and the Female Physician Experience in a Children's Hospital: A Qualitative Study.","authors":"Jennifer N Smith, Romy Cho, Maria Athina Tina Martimianakis, Michelle Shouldice, Indra Narang, Laila Premji","doi":"10.1016/j.jpeds.2025.114705","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114705","url":null,"abstract":"<p><strong>Objectives: </strong>To explore how microaggressions are understood and experienced by female physicians in a pediatric academic hospital and to describe the impact of those microaggressions.</p><p><strong>Study design: </strong>We conducted a qualitative study using in-depth individual interviews completed between March and December 2021. Subjects were included if they were female staff pediatricians at The Hospital for Sick Children, which is affiliated with the University of Toronto, and actively involved in clinical work. Convenience sampling was used and followed by secondary, purposeful sampling to ensure a representative sample of 27 participants who completed interviews; 24 interviews were included in the analysis. Interview transcripts were analyzed for recurrent and emergent themes using grounded theory methodology.</p><p><strong>Results: </strong>All participants provided examples of microaggressions, including environmental microaggressions, microassaults, microinsults, and microinvalidations. Examples of microaggressions were provided, such as being scrutinized in clinical decisions, being mistaken consistently for a trainee or non-physician, and receiving dismissive or degrading comments. Themes regarding impacts of microaggressions included effects on career trajectories, clinical decision making, and self-identity.</p><p><strong>Conclusions: </strong>Microaggressions experienced by female physicians are pervasive even within the female-dominant clinical work environment in an academic pediatric hospital. Understanding these experiences will allow for systemic changes within institutions to improve the culture of pediatric academic medicine.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114705"},"PeriodicalIF":3.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Length of Hospital Stay and Delayed Discharges Among Patients Referred to Child Psychiatry Liaison Services: A Five-Year Retrospective Analysis.","authors":"Laura Bond, Rushil Palavarapu, Aoife Gordon, Ngozi Oketah, Kieran Moore, Elizabeth Barrett, Fiona McNicholas","doi":"10.1016/j.jpeds.2025.114700","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114700","url":null,"abstract":"<p><strong>Objective: </strong>To identify factors contributing to prolonged length of hospital stay (LOS) and delayed discharges (DD) among children referred to Paediatric Consultation-Liaison Psychiatry Services (PLPS) in a tertiary paediatric hospital in Ireland.</p><p><strong>Study design: </strong>A five-year retrospective chart review from April 2019 to May 2024 was conducted, examining demographic, clinical, and systemic data for patients with prolonged admissions (LOS > 30 days) and delayed discharges. Clinician perspectives were gathered through semi-structured interviews; thematic analysis was applied to qualitative data to identify key themes related to discharge barriers.</p><p><strong>Results: </strong>A total of 107 patients met criteria for prolonged LOS. Delays were most commonly attributed to systemic barriers, including limited access to inpatient psychiatric units and inadequate community-based support services, as well as patient-related factors such as complex psychiatric comorbidities (notably eating disorders and neurodevelopmental conditions). Clinician interviews highlighted additional themes, including resource constraints and challenges in discharge planning. Prolonged hospitalization for psychiatric reasons in medical wards was associated with significant strain on resources, delayed treatment, and increased safety concerns.</p><p><strong>Conclusions: </strong>Findings highlight the need for improved interagency collaboration, expanded access to psychiatric inpatient care, and the development of streamlined, resource-appropriate discharge pathways. Addressing these challenges is essential to reduce inappropriate hospital stays and improve outcomes for pediatric patients with mental health needs.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114700"},"PeriodicalIF":3.9,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal Neuroimaging Among Children Born Extremely Preterm and Motor Coordination Impairment at School-Age.","authors":"Susan R Hintz, Carla M Bann, Betty R Vohr, Elisabeth C McGowan, Yvonne E Vaucher, Martha G Fuller, Abhik Das, Deanne E Wilson-Costello, Donna M Garey, Cecelia Keller Sibley, Rosemary D Higgins","doi":"10.1016/j.jpeds.2025.114704","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114704","url":null,"abstract":"<p><strong>Objectives: </strong>To examine among children born extremely preterm (EPT) initial and late cranial ultrasound (CUS) findings and near-term brain MRI findings, including white matter abnormalities (WMA) as markers for motor coordination impairment at school age.</p><p><strong>Study design: </strong>This was a prospective, longitudinal study of neonatal CUS and near-term conventional MRI among infants born 24-27+6/7 weeks' estimated gestational age (EGA) to predict outcomes in a subgroup of the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT). Outcome measures at 6-7 years included Movement Assessment Battery for Children (MABC-2) to determine significant motor impairment (total test score <5^th %ile). Logistic regression was used to evaluate associations with near-term neuroimaging, adjusting for perinatal-neonatal factors.</p><p><strong>Results: </strong>Total test score on MABC-2 was available for 320 children. Nearly 1 in 3 children had significant motor impairment, with rates increasing with decreasing EGA (24 weeks: 41%; 25 weeks: 41%; 26 weeks: 31%; 27 weeks: 21%). Higher rates of impairment were seen with adverse late CUS findings and increasing WMA severity, but importantly, high rates were also seen among those normal late CUS (29%) and without WMA on MRI (22%). Motor impairment was independently associated with adverse late CUS in the group overall (aOR 5.0, 95% CI 1.5-16.3) and with moderate-severe WMA among those without CP (aOR 2.3, 95%CI 1.1-4.9).</p><p><strong>Conclusions: </strong>Although motor coordination impairment was associated with abnormal neonatal neuroimaging, there was a high prevalence among all EPT infants, whether with or without neuroimaging abnormalities. These findings indicate the need for consistent long-term follow-through and intervention.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114704"},"PeriodicalIF":3.9,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}