Journal of Pediatrics最新文献

{"title":"A Multisite Randomized Controlled Trial of Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) for Children with Bilateral Cerebral Palsy.","authors":"Leanne Sakzewski, Yannick Bleyenheuft, Iona Novak, Catherine Elliott, Sarah Reedman, Catherine Morgan, Kerstin Pannek, Natalie Dos Santos, Ashleigh Hines, Sherilyn Nolan, Robert S Ware, Roslyn N Boyd","doi":"10.1016/j.jpeds.2025.114666","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114666","url":null,"abstract":"<p><strong>Objective: </strong>To test the efficacy of Hand Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) to improve gross motor function, manual ability, goal performance, walking endurance, mobility, and self-care for children with bilateral cerebral palsy (CP).</p><p><strong>Study design: </strong>This prospective, waitlist randomized controlled trial included children with bilateral CP, aged 6-to-16-years and classified Gross Motor Function Classification System (GMFCS) levels II to IV. HABIT-ILE delivered for 2 weeks (65 hours) was compared with usual care (UC). Primary outcomes post-intervention were gross motor function (Gross Motor Function Measure-66) and manual ability (ABILHAND-Kids). Secondary outcomes were goal performance (Canadian Occupational Performance Measure), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), bimanual hand performance (Both Hands Assessment), and walking endurance (6 Minute Walk Test). Linear regression models were used to determine between group differences, adjusted for baseline scores.</p><p><strong>Results: </strong>92 children were recruited; two were deemed ineligible after randomization and were excluded. 90 children (HABIT-ILE n=46, UC n=44), mean age 10.4 (SD 3.0) years, GMFCS II=32; III=31; IV=27 were included. HABIT-ILE led to superior gains in manual ability (mean difference 0.85, 95% CI 0.38-1.33; P<0.001) but not gross motor function. HABIT-ILE led to superior changes on goal performance, self-care, and mobility.</p><p><strong>Conclusions: </strong>HABIT-ILE was effective in improving manual ability, mobility, self-care, and goal performance, but not gross motor function. Significant gains immediately post-intervention were retained at 26 weeks. Large individual variability suggests further analyses need to be performed to understand characteristics of children who achieved clinically meaningful gains across outcomes.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114666"},"PeriodicalIF":3.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183220","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":"Prenatal Opioid Exposure is Associated with Punctate White Matter Lesions in Term Newborns.","authors":"Stephanie L Merhar, Carla M Bann, Nicole Mack, Jamie E Newman, Catherine Limperopoulos, Namasivayam Ambalavanan, Jonathan M Davis, Sara B DeMauro, Scott Lorch, Deanne E Wilson-Costello, Myriam Peralta-Carcelan, Lindsay M Parlberg, Brenda B Poindexter, Kushal Kapse, Beth Kline-Fath, Jonathan Murnick","doi":"10.1016/j.jpeds.2025.114669","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114669","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether prenatal opioid exposure is associated with punctate white matter lesions (PWML) on brain magnetic resonance imaging (MRI) in a large prospective cohort of term newborns.</p><p><strong>Study design: </strong>Newborns ≥37 weeks' gestation with prenatal opioid exposure and unexposed controls underwent brain MRI at 0-1 months of age in the prospective observational Outcomes of Babies with Opioid Exposure (OBOE) study. Exposure status was based on maternal self-report and/or maternal or neonatal toxicology screening. MRIs were scored by two pediatric neuroradiologists masked to exposure. Multinomial logistic regression was used to compute odds ratios for PWML by opioid exposure, adjusting for various confounders.</p><p><strong>Results: </strong>Opioid-exposed newborns (n=165) had lower birth weight and smaller head circumference and were more likely to have mothers who smoked, were positive for hepatitis C, and had limited education than unexposed neonates (n=94). 27% of exposed newborns had 1 or more PWML compared with 13% of unexposed newborns (P = .031). After adjusting for covariates, opioid exposure was associated with higher odds of PWML (adjusted odds ratio [aOR] 2.68, 95% CI 1.07-6.72, P = .04), with methadone exposure worse than buprenorphine and other opioids (aOR 3.25, 95% CI 1.21-8.75, P=.02).</p><p><strong>Conclusions: </strong>Prenatal opioid exposure is associated with an increased risk of PWML in newborns, with methadone exposure significantly worse than buprenorphine. As PWML are associated with adverse neurologic outcomes in other populations, follow-up will evaluate if these lesions significantly impact neurodevelopmental outcomes.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114669"},"PeriodicalIF":3.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144504","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":"Body Mass Index Variability during Weight Loss Treatment and Risk Factors for Cardiovascular Disease.","authors":"Eline Vermeiren, Karolien Van De Maele, Marijke Ysebaert, Sanae Makhout, Ann De Guchtenaere, Maria Van Helvoirt, Luc Bruyndonckx, Benedicte De Winter, Stijn Verhulst, Kim Van Hoorenbeeck, Annelies Van Eyck","doi":"10.1016/j.jpeds.2025.114665","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114665","url":null,"abstract":"<p><strong>Objective: </strong>To explore the effect of body mass index BMI variability on cardiometabolic risk in children with obesity.</p><p><strong>Study design: </strong>Children between 8-18 years, entering a 12-month inpatient or 18-month outpatient obesity treatment were studied. BMI, body composition, blood pressure, high-sensitivity C-reactive protein (hs-CRP), lipid profile, insulin sensitivity, and endothelial function were assessed at baseline and follow-up (every three months for outpatients; at 12 and 18 months for inpatients). BMI evolution was modeled via linear regression for each patient, with the slope indicating BMI evolution and root mean square error (RMSE) reflecting BMI variability. These were correlated with changes (Δ) in risk factors between baseline and the final visit.</p><p><strong>Results: </strong>Eighty-three patients were included (mean age 12.8 ± 2.4 years, mean BMI 32.8 ± 5.5 kg/m², 36 boys, 45 inpatient). By 18 months, BMI significantly decreased by 3.5 ± 3.6 kg/m², resulting in an average BMI slope of -0.19 ± 0.21 kg/m²/month and a median RMSE of 2.75 (0.97 - 4.58). The slope significantly related to changes in body composition, insulin sensitivity, hs-CRP, HDL-cholesterol, and endothelial function. The RMSE did not significantly correlate with changes in cardiometabolic factors or endothelial function after correcting for age, sex, and pretreatment BMI and slope, except for a correlation with Δlean% (r=-0.75) and ΔHDL (r=-0.44), both p<0.001.</p><p><strong>Conclusion: </strong>Only overall BMI evolution was significantly related to the cardiometabolic risk factors and endothelial function, indicating that overall weight loss is the most important in children with obesity even if BMI fluctuates during the weight loss process.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114665"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144439","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 Critical Illness, 8-Year White Matter Microstructure, and Motor Function In Children Born Very Preterm.","authors":"Sarvenaz Oloomi, Steven Ufkes, Thiviya Selvanathan, Cecil Chau, Elke Roland, Ting Guo, Vann Chau, Ruth E Grunau, Steven P Miller","doi":"10.1016/j.jpeds.2025.114667","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114667","url":null,"abstract":"<p><strong>Objective: </strong>To assess relationships between neonatal critical illness in children born preterm with white matter maturation and clinical motor and visual-motor integration performance at 8 years.</p><p><strong>Study design: </strong>Prospective longitudinal study of 234 neonates (24-32 weeks gestational age [GA]) recruited from 2006-2013 at a tertiary neonatal intensive care unit. Neonatal critical illness included infection, bronchopulmonary dysplasia, retinopathy of prematurity, severe intraventricular hemorrhage, and significant white matter injury. At age 8 years, children completed visual-motor (Beery-Buktenica Developmental Test of Visual-Motor Integration, 6^th ed.) and motor (Movement Assessment Battery for Children, 2^nd ed.) assessments. Tract-based spatial statistics were used to analyze fractional anisotropy (FA) from diffusion tensor imaging (DTI) acquired at 8 years to measure white matter maturation.</p><p><strong>Results: </strong>Of 226 survivors, 129 children (69 males [53%]) were assessed at 8 years and had high-quality DTI. Neonatal critical illness counts ≥ 3 were associated with 11.8-point decrease in motor (CI -23-(-.55), p=.04) and 11.3-point decrease in visual-motor integration scores (CI -18.2-(-4.5), p=.001), accounting for GA and maternal education. Higher neonatal critical illness counts (p = .04) and lower motor (p < .001) and visual-motor integration (p = .04) scores were related to bilateral reductions in white matter FA in the corpus callosum and motor association pathways, accounting for GA, neonatal brain injury, maternal education, and age at scan.</p><p><strong>Conclusions: </strong>Cumulative critical illness in neonates born preterm is associated with long-term changes in white matter microstructure and maturation, which are related to motor and visual motor performance at school-age. These findings highlight the long-term importance of neonatal intensive care exposures and need for school-age follow-up of children born preterm.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114667"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144503","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":"The Unfinished Science of Preterm Nutrition: Implementing Progress and Navigating Uncertainty Belong in the NICU.","authors":"Camilia R Martin, Richard A Polin","doi":"10.1016/j.jpeds.2025.114668","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114668","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114668"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144505","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":"Impact of Systole Phase on Ventricular Outflow Tract Diameter and Cardiac Output Calculation in Infants Born Preterm: A Clinical Validation Study.","authors":"Macarena García-Gozalo, Rema Nagpal, Karl McNamara, Ashraf Kharrat, Poorva Deshpande, Seungwoo Lee, Faith Zhu, Amish Jain","doi":"10.1016/j.jpeds.2025.114663","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114663","url":null,"abstract":"<p><strong>Objective: </strong>To investigate systolic phase-related variation in measurements of right ventricular outflow tract diameter (RVOTd) and left ventricular outflow tract diameter (LVOTd) and calculated right ventricular ouput (RVO) and left ventricular output (LVO) on targeted neonatal echocardiography (TNE) and examine their clinical applicability.</p><p><strong>Study design: </strong>Based on the hypothesis that clinically reliable methods would yield RVO equal to LVO in the absence of cardiac shunts, allowing for predefined margin of ±15% mean difference (MD%), RVOTd/LVOTd were retrospectively measured at early systole (ES), mid systole (MS), and late systole (LS) to calculate corresponding RVOs/LVOs, for neonates who had a TNE without detectable shunt over a 6-year period (1 TNE/patient). Percent variability related to the systolic phase at measurement were compared between right- and left-sided measures and between different pairs. MD% (95% CI) were calculated for 9 paired RVO/LVO combinations, and absolute MD (95% limits of agreement) were identified using Bland-Altman analysis (BA).</p><p><strong>Results: </strong>Fifty-six neonates were included. Overall, variables varied significantly based on the choice of systolic phase at measurement, greater for the right ventricle (RVOTd vs LVOTd 13.8±6.5% vs 7.5±4.3%, p <0.01; RVO vs LVO 25.3 ± 11.0% vs 14.3 ± 7.9%, p<0.01). A stepwise reduction occurred in all measurements though systole (ES>MS>LS). Of the 9 RVO/LVO pairs, only RVO-LS/LVO-ES showed MD%< ±15% [5.3% (-3.9%,14.6%)] and lowest MD on BA but wide LOA [38 (233, -158) ml/min/kg].</p><p><strong>Conclusions: </strong>The choice of systolic phase at RVOTd/LVOTd measurement is an important source of variability, needing standardization during output calculations on TNE. RVOTd-LS/LVOTd-ES pair may provide clinically acceptable performance for output calculation in neonates.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114663"},"PeriodicalIF":3.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133076","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":"Preterm infant feeding and social determinants of health: a complex relationship.","authors":"Nicole Bando, Prakesh S Shah","doi":"10.1016/j.jpeds.2025.114646","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114646","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114646"},"PeriodicalIF":3.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133147","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":"Association Between Air Pollution, Neighborhood Opportunity, and Pediatric Intensive Care Unit Admissions in Acute Respiratory Illness.","authors":"Zachary Pitkowsky, Andrew F Beck, Cole Brokamp, Carlie Myers","doi":"10.1016/j.jpeds.2025.114662","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114662","url":null,"abstract":"<p><p>This retrospective study examined 673 children admitted to a single pediatric intensive care unit (PICU) for associations between PM2.5 exposure, neighborhood deprivation, and PICU length of stay (LOS) for acute respiratory illness. Higher PM2.5 was correlated with longer LOS, especially during respiratory season. Child Opportunity Index was not independently associated with LOS, but inclusion of this marker strengthened the association between PM2.5 and LOS.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114662"},"PeriodicalIF":3.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121404","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":"Pediatric Exclusivity-Associated Revenues and Labeling Changes, 2013 to 2023.","authors":"Ian T T Liu, Adam J N Raymakers, Ameet Sarpatwari, Aaron S Kesselheim","doi":"10.1016/j.jpeds.2025.114660","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114660","url":null,"abstract":"<p><strong>Objective: </strong>To determine the benefits and costs associated with the Best Pharmaceuticals for Children Act's (BPCA) pediatric exclusivity provision from 2013-2023 by analyzing the trials and label changes derived from the BPCA and the revenues associated with the 6-month extension.</p><p><strong>Study design: </strong>In this retrospective cohort study, public FDA and ClinicalTrials.gov data were used to identify drugs granted BPCA pediatric exclusivity from 2013-2023, evaluate clinical trials, and categorize labeling changes attributable to pediatric exclusivity. For drugs with new generic competition, the commercial SSR Health database was used to evaluate revenues during the extension period.</p><p><strong>Results: </strong>From 2013-2023, 229 clinical trials were conducted under the BPCA and 110 drugs received pediatric exclusivity, resulting in new efficacy labeling for 104 (97%) and new safety labeling for 21 (20%) drugs. Pediatric exclusivity was granted a median of 2.34 (IQR, 1.27-4.19) years prior to generic entry. Forty (36%) drugs granted pediatric exclusivity had generic entry during our study period. Median excess revenue attributable to the incentive was $133.8 million (IQR, $58.8-275.0 million) per exclusivity grant for a total of $9.03 billion.</p><p><strong>Conclusions: </strong>The BPCA generates clinical information for treating children that augments drug labeling, while accounting for substantial revenues to pharmaceutical manufacturers due to delaying generic competition. Changes to implementation of the BPCA could allow more timely and cost-effective acquisition of this information.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114660"},"PeriodicalIF":3.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103252","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":"Fluid Balance in Infants born at 22-23 Weeks' Gestation: Trajectories and Associations with Outcomes.","authors":"Nima Naseh, Edward F Bell, Richard Sindelar, Lena Hellström Westas, Johan Ågren","doi":"10.1016/j.jpeds.2025.114661","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114661","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate fluid balance, sodium intake, and hyperglycemia during the first 2 weeks of life in infants born at 22-23 weeks' gestational age and examine their associations with hospital outcomes.</p><p><strong>Study design: </strong>Retrospective, single-center, cohort study of all infants surviving beyond 72 hours (22-23 weeks; January 2019-June 2024). Total fluid intake (TFI), weight, and urine output (UOP) were collected during the first 14 days, and used to calculate daily insensible water loss (IWL). Daily intake of sodium, plasma sodium (P-Na) and glucose levels, and the occurrence of acute kidney injury (AKI) were recorded. Relationships with bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, and death were analyzed.</p><p><strong>Results: </strong>Survival until discharge was 57% (39/69). The nadir weight loss was -15±6% (mean ± SD) at median 3 (IQR 2-5) days. Average TFI during the first week of life was 176±25 mL/kg/day; peak mean UOP (119±39 mL/kg/day) and IWL (87±54 mL/kg/day) occurred on days 2 and 5, respectively. Median daily sodium intake was 4.6 and 4.5 mmol/kg/d in the first and second weeks, respectively. Hypernatremia (P-Na > 150 mmol/L) occurred in 42% and prolonged (>2 days) hyperglycemia (P-glucose >10 mmol/L) was frequent (87%). AKI occurred in 28%. Mortality was independently associated with weight loss >15% (OR 3.9, 95% CI 1.4-11.1, P=0.013), and AKI (OR 3.5, 95% CI 1.1-11.3, p=0.034).</p><p><strong>Conclusions: </strong>In infants born at 22-23 weeks of gestation, a large loss of body weight and AKI are prevalent during the first two weeks of life, and are associated with increased mortality. Preventing excessive weight loss might improve outcomes.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114661"},"PeriodicalIF":3.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103249","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}