World journal of clinical pediatrics最新文献

{"title":"Chronic postsurgical pain in children: Current evidence and clinical perspectives.","authors":"Poonam Godhwal, Anju Gupta, Aarzoo Sirohi, Nishkarsh Gupta","doi":"10.5409/wjcp.119840","DOIUrl":"10.5409/wjcp.119840","url":null,"abstract":"<p><p>The chronification of acute pain following surgery is increasingly recognized, with a reported prevalence of 10%-63%, likely reflecting the increasing number of surgical interventions performed in the pediatric population. This pain is more severe after high-risk surgeries, such as spine surgery, hernia repair, and thoracotomy. Currently, the literature reports highly variable definitions of chronic postsurgical pain (CPSP) owing to a lack of objective diagnostic parameters. The International Association for the Study of Pain defines CPSP as \"chronic pain that develops or increases in intensity after surgery or a tissue injury and persists beyond three months, without other causes\". This pain can be localized to the surgical field or referred to the affected nerve domain. Similarly, the reported incidence of CPSP in children is largely from low-quality studies and varies between 20% and 50% in the studied population. Its neuropathic features are strongly associated with psychological consequences, functional limitations, and adverse long-term health outcomes. Potential risk factors in the pediatric population include psychosocial behaviors, pre-existing pain, postsurgical pain intensity, and the type of surgery performed. Proposed pathophysiological mechanisms include a pro-inflammatory state after surgery, leading to altered peripheral and central sensitization, genomic factors, epigenetic modifications, and altered brain physiology associated with chronic pain. Understanding the pathophysiology helps target interventions for pre-existing pain, surgery-related pain, anxiety, and opioid-induced hyperalgesia. Preoperative protocolized analgesic strategies, cognitive behavioral therapy, and acupuncture have been tried with varied success rates, although concrete data are lacking. The literature on regional analgesia is still limited in the pediatric population and represents a potential area for further research. Furthermore, rehabilitation interventions addressing postoperative trajectories with early referral to transitional pain clinics may offer promising avenues for improving outcomes. There is a significant knowledge gap, a scarcity of available data on CPSP, and difficulties in addressing pain in the pediatric population, underscoring the need for this review.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"119840"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kynurenine pathway dysregulation in attention-deficit hyperactivity disorder: Impact on N-methyl-D-aspartate receptors and phasic dopamine maturation.","authors":"Takahiko Nagamine","doi":"10.5409/wjcp.120485","DOIUrl":"10.5409/wjcp.120485","url":null,"abstract":"<p><p>Recent evidence highlights a significant shift in the kynurenine pathway (KP) toward a neurotoxic profile in medication-naïve children with attention-deficit/hyperactivity disorder (ADHD). This article contextualizes these metabolic alterations - specifically the reduction in kynurenic acid (KYNA) and the elevation of the quinolinic acid (QUIN)/KYNA ratio - as active drivers of neurodevelopmental pathology rather than mere biomarkers. We hypothesize that chronic KP dysregulation disrupts the \"N-methyl-D-aspartate-dopamine link\", where KYNA deficiency leads to N-methyl-D-aspartate receptor disinhibition, subsequently interfering with the phasic dopaminergic signaling essential for executive function. Furthermore, the convergence of these metabolic signatures with those found in affective disorders provides a biological rationale for the high rates of depressive comorbidity in ADHD. We discuss the potential for targeting the KP, particularly through kynurenine 3-monooxygenase inhibition, to restore glutamatergic homeostasis. Crucially, we address the role of blood-brain barrier permeability in ADHD as a factor that may exacerbate the impact of peripheral kynurenine metabolites on central nervous system function.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"120485"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal varicella zoster transmission from mother, management in a resource-limited setting: A case report.","authors":"Hakim Ullah Wazir, Inayat Ullah, Ali Dad, Zainab Khattak, Humaira, Sadaf Naz, Kamil Ahmad Kamil","doi":"10.5409/wjcp.118387","DOIUrl":"10.5409/wjcp.118387","url":null,"abstract":"<p><strong>Background: </strong>Neonatal varicella is a rare but potentially life-threatening condition resulting from vertical transmission of varicella-zoster virus from mother to newborn in the last 3 weeks of pregnancy or acquired after few days of delivery.</p><p><strong>Case summary: </strong>We present a case of a 15 days old male neonate who contracted varicella within the first two weeks of life, born to a mother with unvaccinated status and exposure to varicella zoster infection within family. Diagnosis was made clinically based on the characteristic rash all over the body and fever, despite the unavailability of gold standard diagnostic tests like polymerase chain reaction. In the absence of varicella-zoster immunoglobulin (VZIG), the neonate was successfully managed with intravenous acyclovir, antibiotics and supportive care. Prompt initiation of antiviral therapy and meticulous supportive care led to a favourable outcomes. This case demonstrates that: (1) Clinical diagnosis of neonatal varicella zoster can be made based on characteristic rash in the absence of gold standard diagnostic tests, facilitating timely management in resource-limited settings; (2) Intravenous acyclovir therapy, in combination with antibiotics and supportive care, is an effective treatment when VZIG is unavailable; and (3) Early recognition and prompt antiviral therapy is crucial in preventing complications and improving outcomes in affected newborns.</p><p><strong>Conclusion: </strong>This case highlights the importance of clinical acumen in diagnosing neonatal varicella and the effectiveness of acyclovir therapy in resource-limited settings, where access to advanced diagnostic tests and specific immunoglobulins may be restricted.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"118387"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sirolimus for the treatment of vascular tumors and malformations in children: A 10-year single-institution retrospective study.","authors":"Nattaporn Thongngam, Lalita Sathitsamitphong, Wipawee Morakote, Supapitch Chanthong, Supawadee Maneekesorn, Rungrote Natesirinilkul, Pimlak Charoenkwan, Chane Choed-Amphai","doi":"10.5409/wjcp.119506","DOIUrl":"10.5409/wjcp.119506","url":null,"abstract":"<p><strong>Background: </strong>Vascular anomalies, including vascular tumors and vascular malformations, are common pediatric conditions that may cause significant morbidity. Although standard treatments are effective in many cases, a subset of patients experiences inadequate responses or has unresectable disease, necessitating alternative therapeutic strategies. Sirolimus has emerged as a targeted treatment option for selected vascular anomalies.</p><p><strong>Aim: </strong>To evaluate treatment outcomes and the safety of sirolimus in children with vascular anomalies.</p><p><strong>Methods: </strong>We conducted a retrospective review of medical records of pediatric patients with vascular anomalies who received sirolimus at Chiang Mai University Hospital between 2016 and 2025. Clinical characteristics, treatment regimens, therapeutic responses, and adverse events were analyzed.</p><p><strong>Results: </strong>Eleven children were included in the study. Five patients had vascular tumors, including two kaposiform hemangioendotheliomas, one composite hemangioendothelioma, and two hemangiomas, while six patients had vascular malformations. Sirolimus was administered as salvage therapy in nine patients. After sirolimus treatment, 10 patients (90.9%) achieved partial response, and one patient had stable disease. At a median follow-up of 30 months, all patients were alive with disease. Sirolimus-related adverse events occurred in four patients, with proteinuria being the most common. Other events included hypokalemia, elevated serum creatinine, and hypercholesterolemia. No serious infections were observed.</p><p><strong>Conclusion: </strong>Sirolimus demonstrated a high response rate and an acceptable safety profile in children with vascular anomalies. These findings support the use of sirolimus as an effective treatment option for refractory or unresectable cases, including complex entities such as composite hemangioendothelioma.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"119506"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric kidney transplant disparities.","authors":"Sathyaprasad C Burjonrappa, Sanjana Eranki, Jasmin Capellan","doi":"10.5409/wjcp.117940","DOIUrl":"10.5409/wjcp.117940","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation (KT) is essential for end-stage renal disease, significantly improving survival and quality of life. Yet, in pediatric renal disease management, minority children face poorer dialysis outcomes and reduced access to transplantation.</p><p><strong>Aim: </strong>To identify and understand these differences in the pediatric population.</p><p><strong>Methods: </strong>Using ICD-10 codes, we queried the 2022 Health Care Cost and Use Project Kid's Inpatient Database for admissions with a primary or secondary diagnosis of severe chronic kidney disease (sCKD), namely stages 4 and 5, or a KT procedure. Patient demographics, insurance types, and hospital stay metrics were assessed through statistical analyses including Wilcoxon Rank Sum, <i>χ</i> ², and logistic regression.</p><p><strong>Results: </strong>A total of 636 hospital admissions related to KT surgery and 3733 hospital admissions with sCKD as the primary diagnosis were identified. In both the KT and sCKD cohorts, most patients were White (42.6% <i>vs</i> 36.6%), male (59.8% in both groups), aged 12-18 years (57.9% <i>vs</i> 50.3%), and insured by Medicaid (35.7% <i>vs</i> 43.0%). KT and sCKD hospitalizations were uncommon among infants aged 0-1 year (1.6% and 9.9%, respectively). Analysis of income quartiles based on patients' residential zip codes demonstrated no significant differences between those who underwent KT and those with sCKD without transplant. Although mortality rates did not differ statistically between groups, a numerical difference was observed, with higher mortality in the sCKD cohort compared to the KT cohort (16 deaths <i>vs</i> 4 deaths).After adjusting for socioeconomic and geographic factors, Black race was independently associated with lower odds of undergoing KT (adjusted odds ratio 0.69; 95% confidence interval: 0.53-0.89).</p><p><strong>Conclusion: </strong>Pediatric KT recipients were more likely to be male, White, and aged 12-18 years. Racial disparities persist, with ethnic minority groups-particularly Black patients-facing reduced access to KT. These findings underscore the necessity of implementing targeted interventions to promote equitable access to pediatric KT.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"117940"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction and performance of the A8+ TouchCare Nano in children and adolescents with type 1 diabetes mellitus.","authors":"Konstantina Kosta, Maria G Grammatikopoulou, Ilektra Toulia, Penelope Smyrnaki, Eleni G Paschalidou, Anastasios Vamvakis, Antonios Bogiatzoglou, Christos Tzimos, Kyriaki Tsiroukidou","doi":"10.5409/wjcp.118236","DOIUrl":"10.5409/wjcp.118236","url":null,"abstract":"<p><strong>Background: </strong>The role of automated insulin delivery systems in type 1 diabetes mellitus (T1DM) is constantly expanding, merging continuous glucose monitoring readings with a control algorithm and a continuous subcutaneous insulin infusion device, <i>i.e.</i> insulin pump.</p><p><strong>Aim: </strong>To evaluate the effectiveness of a new, open and closed-loop insulin delivery system in children and adolescents with T1DM.</p><p><strong>Methods: </strong>Children and adolescents with T1DM (<i>n</i> = 28) were recruited from two pediatric endocrinology clinics situated in Thessaloniki and Crete (Greece), during the year 2025. The Medtrum A8+ TouchCare Nano system was used on all patients and comparison of glycemic control and treatment satisfaction were evaluated before and after the introduction of the new system.</p><p><strong>Results: </strong>The results showed increased patient satisfaction with the continuous subcutaneous insulin infusion, in particular when the closed-loop system was integrated. Participants were satisfied with most of the system's features, including the predictive low glucose suspend feature, aiming in preventing hypoglycemic episodes and the Auto Meal Handling feature, adjusting the carbohydrate content of each meal without necessitating carbohydrate counting. Time in range, glycosylated haemoglobin levels glucose management indicator, time above range, very high glucose levels, time in tight range and average blood glucose levels were improved after the introduction of the new system. The results remained similar even when closed/open loop systems were evaluated, or when the sample was divided in pre-pubertal/pubescent participants. No adverse events were recorded.</p><p><strong>Conclusion: </strong>The results indicate the that Medtrum A8+ TouchCare Nano system is safe and effective in maintaining and improving glycemic control in children and adolescents with T1DM. More research on pediatric patients is required to further verify these results.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"118236"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vardenafil efficacy for the treatment of persistent pulmonary hypertension of the newborn.","authors":"Sania El-Hindi","doi":"10.5409/wjcp.118862","DOIUrl":"10.5409/wjcp.118862","url":null,"abstract":"<p><strong>Background: </strong>Persistent pulmonary hypertension of the newborn (PPHN) remains a challenging condition with high morbidity and mortality despite advancements in management, which implies the need to investigate new therapies. While sildenafil is the drug of choice in resource-limited centers and for patients unresponsive to inhaled nitric oxide, alternative phosphodiesterase-5 inhibitors like vardenafil may offer superior efficacy.</p><p><strong>Aim: </strong>To assess the efficacy of vardenafil in the management of persistent pulmonary hypertension in newborns.</p><p><strong>Methods: </strong>This randomized, double-blind, controlled, parallel clinical trial was conducted at Children's Hospital, Damascus University. Fifty-five newborns (32 females and 23 males, < 96 hours old) with moderate to severe PPHN were allocated at a 1:2 ratio to receive 2 mg/kg/day oral sildenafil (<i>n</i> = 18) or 0.4 mg/kg/day oral vardenafil (<i>n</i> = 37). Recruitment lasted from May 2023 until September 2024<i>.</i> Clinical and echocardiographic findings were monitored daily from diagnosis until pulmonary pressure normalization.</p><p><strong>Results: </strong>The vardenafil group showed more rapid improvement. Pulmonary hypertension decreased significantly in the vardenafil group after 1 and 2 days (<i>P</i> = 0.002 and <i>P</i> < 0.001 respectively). Similarly, pulmonary vascular resistance decreased significantly in the vardenafil group after 1 day and 2 days (<i>P</i> = 0.001 and <i>P</i> = 0.015 respectively). Additionally, pulmonary artery flow velocity increased more in the vardenafil group after 1 day and 2 days (<i>P</i> = 0.046 and <i>P</i> = 0.048 respectively) and respiratory distress scores improved more in the vardenafil group after 2 days and 3 days of treatment (<i>P</i> = 0.048 and <i>P</i> = 0.004 respectively). No adverse events were reported in either treatment group.</p><p><strong>Conclusion: </strong>Vardenafil at 0.4 mg/kg/day has superior efficacy compared with sildenafil at 2 mg/kg/day in improving echocardiographic and clinical outcomes in patients with PPHN, with comparable safety profiles. These findings suggest vardenafil may be a valuable option for PPHN management.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"118862"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modality matters: Effect of dialysis modality on soluble intercellular adhesion molecule-1 in children on regular hemodialysis.","authors":"Mohammed F Kasem, Ragia M Said, Doaa R Dahshan, Samar H Elhadedy, Noha R Mohammed, Noha U Hashem","doi":"10.5409/wjcp.120090","DOIUrl":"10.5409/wjcp.120090","url":null,"abstract":"<p><strong>Background: </strong>Intercellular adhesion molecule-1 (ICAM-1) plays a key role in mediating leukocyte adhesion and endothelial injury. Elevated circulating levels of soluble ICAM-1 (sICAM-1) in patients undergoing hemodialysis (HD) have been linked to a higher incidence of cardiovascular complications.</p><p><strong>Aim: </strong>To evaluate the impact of dialysis modality and membrane performance on post-dialysis sICAM-1 levels in children undergoing maintenance HD.</p><p><strong>Methods: </strong>This study included 26 children on low-flux HD for at least 3 months and 26 sex-matched and age-matched healthy controls. Patients were shifted to high-flux HD for 3 months, then subsequently to post-dilutional online hemodiafiltration (OL-HDF) for additional 3 months. At the end of each study phase, blood samples were obtained before and after a mid-week HD session for sICAM-1 measurement. To account for hemoconcentration, post-session ICAM-1 were hematocrit-adjusted using van Beaumont's formula yielding corrected ICAM-1 (cICAM-1).</p><p><strong>Results: </strong>Circulating post-dialysis cICAM-1 levels increased significantly after low-flux HD compared with the corresponding pre-dialysis levels (<i>P</i> = 0.002), and were also significantly higher than those of the control group (<i>P</i> < 0.001). Following conversion to high-flux HD, post-dialysis cICAM-1 concentrations decreased significantly compared to pre-dialysis values (<i>P</i> < 0.001), although they remained elevated compared to controls (<i>P</i> = 0.026). In contrast, OL-HDF was associated with a substantial decline in post-session cICAM-1 levels (<i>P</i> < 0.001), yielding values comparable to those observed in the control group (<i>P</i> = 0.898).</p><p><strong>Conclusion: </strong>Children on maintenance HD exhibit elevated sICAM-1 levels. Our findings suggest that higher-efficiency dialysis modalities, such as OL-HDF, may attenuate dialysis-related inflammation and endothelial activation in these patients.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"120090"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting modifiable determinants of bronchopulmonary dysplasia in very preterm infants.","authors":"Pushparaj Nilkanth Patil","doi":"10.5409/wjcp.120197","DOIUrl":"10.5409/wjcp.120197","url":null,"abstract":"<p><p>In infants who are born with a gestational age of 32 weeks or less, bronchopulmonary dysplasia (BPD) is persistently a significant cause of morbidity. Early gestational age, low birth weight, prolonged mechanical ventilation, prolonged oxygen exposure, and neonatal sepsis were found to be important predictors of BPD in Palestinian private hospitals by Algharabeh <i>et al</i> in a retrospective cohort study published in <i>World Journal of Clinical Pediatrics</i>. These results underline the ongoing significance of modifiable postnatal exposures and support the complex character of BPD. The study additionally shows several significant maternal-newborn relationships, including preeclampsia and patent ductus arteriosus, eclampsia and neonatal sepsis, preterm rupture of membranes and retinopathy of prematurity (ROP), and multiple gestations with late-onset sepsis and ROP. Impaired alveolarization and aberrant pulmonary vascular development due to oxidative stress, inflammation, and ventilator-associated lung injury are the main features of BPD. These findings necessitates the need for lung-protective ventilation strategies, judicious use of oxygen, infection prevention and control, and improvement in maternal health. The study by Algharabeh <i>et al</i> has limitations like a retrospective design and a single-center setting. But still, it provides useful insights and highlights the need for further prospective research design to refine prevention strategies and improve adverse respiratory outcomes.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"120197"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of breast milk composition on nutritional status of term neonates with congenital heart defects: A prospective study.","authors":"Aleksandra V Kaplina, Tatiana A Fedoseeva, Tatiana M Pervunina, Olga V Kalinina, Olga O Shemyakina, Tatiana G Barakova, Maria V Kim, Natalia A Petrova","doi":"10.5409/wjcp.v15.i2.112072","DOIUrl":"10.5409/wjcp.v15.i2.112072","url":null,"abstract":"<p><strong>Background: </strong>Congenital heart defects (CHDs) are the most common congenital malformations, often requiring surgical intervention during the early neonatal period. Although most children with CHDs are born at full term with appropriate birth weights, many of them develop malnutrition during the first weeks of life, resulting in complications after cardiac surgery. This study aimed to provide new insights into personalized nutritional interventions based on variations in breast milk (BM) composition. We hypothesized that the nutritional and energy composition of BM is associated with the growth trajectory during the late neonatal period in neonates with CHDs, and it may guide individualized nutrition support.</p><p><strong>Aim: </strong>To assess the BM composition in mothers of neonates with CHD and evaluate its role in the nutritional status of these neonates.</p><p><strong>Methods: </strong>In this single-center prospective non-interventional study, we analyzed the BM composition in 35 mothers of neonates with CHDs (25 operated, 10 non-operated) at V1 (2-5 days), V2 (7-12), and V3 (14-40), and also in 21 mothers of healthy infants at V1 (<i>n</i> = 21) and V2 (<i>n</i> = 12), using the Miris Human Milk Analyzer. The weight-for-age <i>z</i> score (WAZ) at discharge was assessed in infants with CHD. Associations between the BM composition, nutrient intake, postoperative course, and WAZ change were evaluated.</p><p><strong>Results: </strong>Only the colostrum fat concentration was significantly lower in mothers of operated neonates [2.4 (2.0-2.6) g/100 mL] compared with mothers of non-operated neonates [2.9 (2.2-3.1) g/100 mL] and controls [2.7 (2.3-3.3) g/100 mL] (<i>P</i> = 0.045). Operated neonates exhibited a greater decrease in WAZ from birth to discharge than non-operated neonates (<i>P</i> = 0.008). Postoperative WAZ decline was associated with the postoperative period severity and delayed reintroduction of BM feeding. Higher calorie and fat intake on postoperative day 14 was significantly associated with a smaller WAZ decrease (<i>P</i> < 0.05). Later postoperative achievement of full enteral feeding independently predicted WAZ decline. In the operated group the colostrum protein content positively correlated with weight gain during the early neonatal period.</p><p><strong>Conclusion: </strong>Colostrum from mothers of operated neonates with CHD had reduced fat content. BM composition did not affect WAZ trajectories. However, delayed achievement of full enteral feeding independently predicted WAZ decline.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"112072"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}