BMJ Paediatrics Open最新文献

{"title":"Impact of early life antibiotic exposure on the preschool developmental status: a nationwide population-based study.","authors":"Ye Kyung Kim, Peong Gang Park","doi":"10.1136/bmjpo-2025-003361","DOIUrl":"10.1136/bmjpo-2025-003361","url":null,"abstract":"<p><strong>Objective: </strong>Growing concerns exist about the potential adverse effects of early antibiotic exposure on neurodevelopmental outcomes. However, large-scale studies exploring these implications in early childhood are rare.</p><p><strong>Design: </strong>A nationwide, population-based retrospective cohort study using data from the Korean National Health Insurance System and the National Health Screening Program for Infants and Children (NHSPIC) between 2015 and 2022.</p><p><strong>Patients: </strong>A total of 1 848 841 children who participated in the NHSPIC at both 4-6 months and 54-60 months of age were included.</p><p><strong>Interventions: </strong>Antibiotic exposure under 90 days old.</p><p><strong>Main outcome measures: </strong>Developmental delays in preschool-aged children assessed by the Korean Developmental Screening Test at 54-60 month of age.</p><p><strong>Results: </strong>Among the 1 848 841 children assessed, 23% experienced antibiotic exposure within the first 3 months of life. Early use of antibiotics was linked to a slightly elevated risk of developmental delays at a median age of 4.94 years (OR 1.03, 95% CI 1.00 to 1.17), particularly affecting gross motor (OR 1.08, 95% CI 1.04 to 1.13), fine motor (OR 1.09, 95% CI 1.05 to 1.13), cognition (OR 1.08, 95% CI 1.04 to 1.13) and communication (OR 1.08, 95% CI 1.04 to 1.12). A dose-response relationship was also observed, with longer durations of antibiotic exposure associated with an increased risk of developmental delays.</p><p><strong>Conclusions: </strong>Exposure to antibiotics in infants under 90 days old may be associated with a modest increase in the risk of global developmental delays, especially in motor skills, cognitive functions and communication abilities. Careful consideration is necessary when prescribing antibiotics to this age group.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost of diarrhoea: a household perspective from seven countries in the Global Enteric Multicentre Study (GEMS).","authors":"Md Fuad Al Fidah, Md Ridwan Islam, Rukaeya Amin, Sharika Nuzhat, Tahmeed Ahmed, Abu Syed Golam Faruque","doi":"10.1136/bmjpo-2025-003622","DOIUrl":"10.1136/bmjpo-2025-003622","url":null,"abstract":"<p><strong>Background: </strong>The burden of diarrhoeal diseases is considerable in South Asia, as well as in sub-Saharan Africa. Its economic impact is more profound in resource-limited settings like low-income and middle-income countries (LMICs). In this study, we aimed to estimate the direct and indirect costs reported by the caregivers of participants from seven LMICs.</p><p><strong>Methods: </strong>The current study is a secondary analysis using data from the multicentre, Global Enteric Multicentre Study, which enrolled under-5 children. This prospective case-control study was conducted in seven sites, all of which were in LMICs. After adjustment for inflation, cost data were collected from the caregivers and converted into international dollar (I$). Quantile regression models were developed after adjusting for age, sex and country.</p><p><strong>Results: </strong>This study analysed data from 4592 participants. The median (IQR) total direct cost (TDC) and total indirect cost (TIC) were I$8.4 (I$11.0) and I$10.2 (I$14.3), respectively. Statistically significant differences were found across continents for multiple variables. The highest median TDC and TIC were in Bangladesh (I$13.6 and I$23.2, respectively), while mozambique reported the lowest (I$0.4 and I$4.9, respectively), with medication accounting for 60.9% of TDC. Quantile regression analysis showed TDC was positively associated with factors like family size, urban residence, moderate-to-severe disease, caregiver education and use of rehydration methods, while treated drinking water and overweight status were negatively associated. TIC was significantly associated with seeking prior care.</p><p><strong>Conclusions: </strong>The indirect cost of diarrhoea was higher, which indicates the impact of lost productivity due to the disease. Bolstering the healthcare financing systems, ensuring affordable medication using pricing regulation, subsidising treatment packages, promoting the water, sanitation and hygiene (WASH) initiative, promoting and practising standard case management, and timely healthcare-seeking can reduce the economic burden.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic costs of health and social care for a child with a life-limiting condition in their last year of life: a systematic review.","authors":"Louise Prendergast, Ellie Crane, Nathan Bray, Jane Noyes","doi":"10.1136/bmjpo-2025-003526","DOIUrl":"10.1136/bmjpo-2025-003526","url":null,"abstract":"<p><strong>Aim: </strong>To systematically review and descriptively synthesise the costs associated with any health and/or social care services provided to children with a life-limiting condition, in their last year of life.</p><p><strong>Methods: </strong>Systematic review using MEDLINE, EMBASE, CENTRAL Cochrane Library, CINAHL and other specialist databases to identify articles published between 2004 and 2024. Duplicates were removed and two authors screened the articles and abstracts independently. Full-text articles were assessed for eligibility, with quality assessment conducted using the Drummond checklist. The findings were exported into tables and summarised narratively. Costs from each study were calculated per person per month and inflated to 2024 US dollars.</p><p><strong>Results: </strong>20 records were eligible for final inclusion. Services reported were varied as were approaches to estimating costs. In general, younger children required more intensive and higher cost care. Costs increase in the final months of life, and specialist paediatric palliative care interventions were associated with overall lower costs through reductions in hospital admissions and length of stay.</p><p><strong>Conclusions: </strong>It was not possible to present a reliable robust estimate of the economic costs of services and resources due to limited and heterogenic data. Further research is needed to identify the full range of resources, and services associated with caring for children with life-limiting conditions in their last year of life, to support healthcare planning and resource allocation.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of timing of initial breastfeeding and neonatal outcome in very preterm infants: a multicentre cohort study in China.","authors":"Rong Lin, Zhihui Rong, Rong Zhang, Zhi Zheng, Ya Ding, Chao Ning, Yun Cao, Chen Chao, Jie Yang, Xinzhu Lin","doi":"10.1136/bmjpo-2025-003485","DOIUrl":"10.1136/bmjpo-2025-003485","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between the timing of initial breastfeeding and the risk of necrotising enterocolitis (NEC) and other neonatal outcomes in very preterm infants (VPIs, <32 weeks' gestation).</p><p><strong>Design: </strong>Multicentre observational cohort study.</p><p><strong>Setting: </strong>Data were collected from 102 tertiary neonatal intensive care units (NICUs) in China between 2019 and 2023 through the Chinese Neonatal Network.</p><p><strong>Patients: </strong>A total of 12 679 VPIs admitted to NICUs within 24 hours of birth and initially breastfed within 7 days were included.</p><p><strong>Interventions: </strong>Infants were categorised into four groups based on initial breastfeeding timing: within 24 hours (n=2242), 24-48 hours (n=3657), 48-72 hours (n=1870) and after 72 hours (n=4910, reference group).</p><p><strong>Main outcome measures: </strong>The primary outcome was NEC (stage ≥2). Secondary outcomes included mortality, bronchopulmonary dysplasia, severe neurological injury, severe retinopathy of prematurity, late-onset sepsis, NICU length of stay and intravenous nutrition duration.</p><p><strong>Results: </strong>Early breastfeeding initiation (<24 hours) was associated with a higher incidence of NEC (7.5% vs 4.3%, OR 1.92, 95% CI 1.21 to 3.06). No significant NEC risk increase was observed for feeding initiation after 24 hours. Early breastfeeding was linked to a shorter duration of intravenous nutrition (median 15 days (IQR 10-27) vs 22 days (IQR 14-33), mean difference -3.93 days, 95% CI -6.57 to -1.3). Subgroup analysis revealed increased NEC risk in neonates delivered via caesarean section, those receiving blood transfusions and those born <28 weeks' gestation.</p><p><strong>Conclusions: </strong>While early breastfeeding initiation (<24 hours) reduces intravenous nutrition duration, it may elevate NEC risk in specific high-risk subgroups. Feeding strategies should be individualised based on gestational age, delivery mode and transfusion status. Further randomised trials are needed to optimise early feeding protocols for VPIs.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring inequality through the lens of adolescents: a photovoice study in Bissau, Guinea-Bissau.","authors":"Fatou N Dure Baboudóttir, Zeca Jandi, William Gomes Ferreira, Jónína Einarsdóttir, Geir Gunnlaugsson","doi":"10.1136/bmjpo-2025-003529","DOIUrl":"10.1136/bmjpo-2025-003529","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic determinants of health are well-documented, yet adolescents' perspectives are often under-represented. The study aimed to engage adolescents in a low-income sub-Saharan setting to explore their daily experiences and analyse their perceptions of inequality within their local environment.</p><p><strong>Methods: </strong>A photovoice project was conducted from January to March 2024 with six adolescents aged 16-19 years in Bissau, the capital of Guinea-Bissau. Participants used disposable cameras to capture up to 15 photos each, representing daily inequalities and documented reflections through narratives using the PHOTO method, that is, writing notes about the photo, its context and potential implications for change. After 2 weeks, participants selected key images and engaged in a focus group discussion to analyse their photos. Thematic analysis was conducted using Atlas.ti.</p><p><strong>Results: </strong>Four themes of inequality emerged: education, health and sanitation, environment and economy. Adolescents highlighted inadequate access to healthcare and sanitation facilities, environmental degradation, disparities between public and private schools and economic hardship limiting access to education and work. Their narratives revealed frustration over systemic barriers, yet demonstrated awareness and creativity in navigating challenges.</p><p><strong>Conclusions: </strong>Adolescents' visual narratives provide insights into their experiences of inequality, highlighting the value of participatory methods in amplifying youth voices. The findings suggest the need for equity-focused interventions addressing structural determinants for inequality across the four identified themes. Including adolescents in policy development is important to promote social justice and their well-being.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anorectal malformation and outcome review (ARMOUR) project: a systematic review for the outcomes reported in patients with an anorectal malformation.","authors":"Layla Hassan, Charlotte B M Rosenberg, Shauna A M Cortenraad, Merel L Kimman, Michel Haanen, Wim G van Gemert, Ruben Gerardus Johannes Visschers","doi":"10.1136/bmjpo-2024-003192","DOIUrl":"10.1136/bmjpo-2024-003192","url":null,"abstract":"<p><strong>Background: </strong>Being born with an anorectal malformation (ARM) often leads to lifelong issues with faecal and urinary function, as well as challenges in sexual, emotional and psychosocial development. Even when anatomical correction is achieved, full functional recovery is not guaranteed. Despite several international consensus meetings with leading medical professionals in the ARM field, there is still no agreement on the essential outcome domains that should be measured for ARM treatment and follow-up. Therefore, the goal of this systematic review is to identify all the outcomes reported in literature.</p><p><strong>Methods: </strong>This systematic review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aiming to identify all short- and long-term outcomes in ARM studies. A literature search was conducted in PubMed and Embase for studies from 1 January 2009 to 1 May 2023, using terms related to 'anorectal malformation'. The Cochrane Library was also searched, but no relevant reviews were found. Eligibility criteria included studies mentioning ARM outcomes in the title or abstract. Exclusions were non-mention of ARM outcomes, lack of full text, and non-English or non-Dutch language. Data extraction by two reviewers captured author details, study design, patient characteristics, ARM types and outcomes, categorised by occurrence time and reporter. Outcomes were consolidated from 339 unique outcomes into 25 domains according to the Core Outcome Measures in Effectiveness Trial () taxonomy and categorised into five core areas: 'mortality/survival', 'physiological/clinical', 'life impact', 'resource use' and 'adverse events'.</p><p><strong>Results: </strong>Out of 348 eligible studies, 118 met the inclusion criteria. These were mostly conducted in Europe (47%), Asia (34%) and North America (11%), with designs including retrospective (36%), cross-sectional (23%) and case reports/series (18%). Patient numbers ranged from 1 to 1206, with many studies lacking clear descriptions of surgical techniques (29%) and age categories (21%). A total of 339 outcomes were identified, categorised into 25 domains per the COMET taxonomy. Mentioned most frequently were 'physiological/clinical' outcomes (772 mentions), with 'gastrointestinal outcomes' being predominant. Long-term outcomes were most common (71%), followed by both short and long term (16%), and short term (13%). Outcomes were mainly reported by medical professionals (59%), with only 10% being patient-reported outcomes. Various measurement tools were used, including validated and self-made instruments, with the international classification (Krickenbeck) being the most used rating scale for postoperative results. Many studies lacked detailed descriptions and validation of their measurement methods.The identified outcomes in this review will be used as an input to eventually develop a Core Outcome Set.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of early sodium supplementation on weight gain of very preterm infants: a randomised controlled trial.","authors":"Anvesh Amiti, Umamaheswari Balakrishnan, Usha Devi, Prakash Amboiram, Abdul Gani Salahudeen","doi":"10.1136/bmjpo-2025-003444","DOIUrl":"10.1136/bmjpo-2025-003444","url":null,"abstract":"<p><strong>Background and objectives: </strong>Preterm neonates are at risk of impaired growth. Hyponatraemia in preterm neonates is due to renal immaturity and can lead to growth failure. We aimed to assess the effect of early enteral sodium supplementation on weight gain velocity from birth to 34 weeks postmenstrual age in preterm neonates.</p><p><strong>Methods: </strong>In this double-blinded randomised controlled trial, we recruited neonates born between 25 weeks and 30 weeks+6 days of gestation who received a minimum feed volume of 100 mL/kg/day before 10 days of life. In the intervention group, 4 mEq/kg/day of oral sodium was administered using 15% saline and, in the control group, normal saline was given as a placebo. The primary outcome was mean weight gain velocity in g/kg/day.</p><p><strong>Results: </strong>A total of 104 neonates were recruited with 52 infants in each group. Mean (SD) weight gain velocity (g/kg/day) was significantly greater in intervention than in control group (18.0±4.4 vs 14.4±3.9; mean difference 3.6 with 95% CI 2.04 to 5.27, p<0.001). Linear growth (cm/week) was greater in intervention than in control group (0.88±0.18 vs 0.73±0.28 cm/week; mean difference 0.14 with 95% CI 0.05 to 0.24, p=0.04). Subgroup analysis in extreme preterm showed similar results. There was no significant difference in head growth or clinical outcomes between the groups.</p><p><strong>Conclusion: </strong>Early postnatal sodium supplementation improves in-hospital weight gain and linear growth in very preterm neonates.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning-based risk prediction models for bronchopulmonary dysplasia in preterm infants: a high-altitude cohort study.","authors":"Heng Zhang, Fei Wang, Ou Jiang, Yilin Lin, Lianfang Tang, Ziwei Li, Rui Ba, Xiaoyan Xu, Hongying Mi","doi":"10.1136/bmjpo-2025-003652","DOIUrl":"10.1136/bmjpo-2025-003652","url":null,"abstract":"<p><strong>Background: </strong>Bronchopulmonary dysplasia (BPD) is a significant cause of morbidity in preterm infants, yet its development and severity at high altitudes (>1500 m) remain poorly understood. This study aimed to identify altitude-specific risk factors and develop robust, interpretable predictive models for BPD in this unique population.</p><p><strong>Methods: </strong>In this retrospective matched cohort study, 378 preterm infants (<32 weeks gestation, <1500 g birth weight) admitted to a high-altitude (1500 m) NICU(Neonatal Intensive Care Unit) between 2019 and 2023 were analysed. The cohort included 189 BPD cases (91 mild, 61 moderate, 37 severe) and 189 matched controls. Maternal, perinatal and postnatal data were collected. Machine learning models (XGBoost, logistic regression, random forest) were developed and rigorously evaluated using comprehensive performance metrics to predict BPD occurrence and severity. SHAP (SHapley Additive exPlanations) analysis was employed to interpret the best-performing model.</p><p><strong>Results: </strong>Key risk factors for BPD development included maternal hypertension (OR 2.31, 95% CI 1.56 to 3.42), initial oxygen requirement >30% (OR 3.15, 95% CI 2.13 to 4.65) and lack of exclusive breast milk feeding (OR 1.89, 95% CI 1.28 to 2.79). Severe BPD was independently associated with prolonged invasive ventilation (>7 days) (OR 4.12, 95% CI 2.78 to 6.11), elevated C reactive protein (>10 mg/L) (OR 2.87, 95% CI 1.93 to 4.26) and patent ductus arteriosus (OR 2.53, 95% CI 1.71 to 3.74). Machine learning models demonstrated strong predictive performance; the optimal XGBoost model achieved an area under the curve of 0.89 (95% CI 0.85 to 0.93), an F1 score of 0.82, a Matthews Correlation Coefficient of 0.73 and a balanced accuracy of 0.85. SHAP analysis identified initial FiO2 >30%, mechanical ventilation and maternal hypertension as the top three most influential predictors for the XGBoost model.</p><p><strong>Conclusions: </strong>This study provides the first comprehensive analysis of BPD risk factors at a specific high altitude and validates effective, interpretable machine learning models for its prediction. These findings highlight the critical importance of altitude-specific adjustments in risk assessment and emphasise the potential for model-guided early interventions to improve outcomes for this vulnerable population.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory health of street and working children: challenges and opportunities.","authors":"Samyuktha Umashankar, Ramiyya Tharumakunarajah, Alice Lee, Sugandi Savithri, Daniel B Hawcutt, Ian P Sinha","doi":"10.1136/bmjpo-2024-002676","DOIUrl":"10.1136/bmjpo-2024-002676","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia.","authors":"Abdulrahman Almehaid, Lina Alsherbini, Mohanned Alrahili, Mohammed Almahdi, Saud Aljadaan, Omar Abbas, Norah S Alsabti, Ghiada A Almutairi, Sarah F Almujarri, Ashwag Alsubaie, Mashael Almutairi, Ahmed Alwatban, Abdulaziz Homedi, Saif Alsaif, Kamal Ali","doi":"10.1136/bmjpo-2025-003667","DOIUrl":"10.1136/bmjpo-2025-003667","url":null,"abstract":"<p><strong>Objective: </strong>To compare risk factors, surgical management, nutritional outcomes and short-term neonatal morbidity and mortality between preterm infants diagnosed with spontaneous intestinal perforation (SIP) and necrotising enterocolitis (NEC).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level III neonatal intensive care unit at a tertiary centre in Riyadh, Saudi Arabia.</p><p><strong>Patients: </strong>Preterm infants born at <32 weeks' gestation diagnosed with either SIP (n=42) or NEC (n=60) between January 2016 and December 2024.</p><p><strong>Main outcome measures: </strong>Clinical characteristics, surgical intervention, nutritional outcomes, major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent predictors of mortality and prolonged parenteral nutrition (PN >60 days).</p><p><strong>Results: </strong>Infants with SIP were diagnosed earlier (median 7 vs 20 days; p<0.001), had lower gestational age and birth weight and more often received postnatal hydrocortisone. Peritoneal drainage was the predominant surgical approach in SIP (98% vs 45%, p<0.001), whereas infants with NEC underwent more laparotomies (67% vs 5%) and stoma formation (42% vs 0%; both p<0.001). Infants with NEC had longer PN duration (48 vs 41 days, p=0.003), higher incidence of PN >60 days (46% vs 24%, p=0.028) and more PN-associated cholestasis (60% vs 36%, p=0.013). Growth failure at discharge was common (NEC 81%, SIP 73%). Major IVH was more frequent in SIP (41% vs 17%, p=0.007), while ROP needing therapy was more common in NEC (75% vs 52%, p=0.016). Independent predictors of mortality included sepsis (Adjusted OR (aOR) 10.5, 95% CI 2.67 to 41.22) and lower gestational age (aOR 1.35, 95% CI 1.04 to 1.77). NEC diagnosis predicted prolonged PN (aOR 0.20 for SIP vs NEC, 95% CI 0.07 to 0.58).</p><p><strong>Conclusions: </strong>SIP and NEC differ significantly in timing of onset, surgical approach and nutritional trajectory. NEC is associated with greater surgical complexity and nutritional morbidity. These findings support the development of condition-specific surgical and feeding protocols.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}