European Journal of Pediatrics最新文献

Ankyloglossia, or tongue-tie, is a variation in the anatomy of the lingual frenulum that restricts tongue movement. It is recognised as a cause of breastfeeding difficulty. We prospectively collected data from a specialist tongue-tie assessment clinic and evaluated mothers' experience using a questionnaire. We prospectively collected data from the specialist tongue-tie assessment clinic from January 2023 to October 2023 to assess factors that may influence a lingual frenotomy in an infant. Mothers were invited to complete two questionnaires, one baseline in the clinic waiting room and one follow-up, 4 weeks after their clinic visit. These self-reported questionnaires assessed breastfeeding challenges, the mother's motivation for seeking an opinion regarding ankyloglossia, and the continuity of breastfeeding 4 weeks following the clinic visit. During these 10 months, 157 infants attended the clinic, and 96 frenotomies were performed. One hundred one participants completed baseline questionnaires, and 34 participants completed follow-up questionnaires. When mothers were asked why they wanted their baby assessed for a tongue-tie, the most common answers were difficulty with latch and nipple pain, reported by 45% and 40%, respectively. The average reported pain while breastfeeding was scored at 2.53, graded from 0 to 5 in the baseline questionnaire. This improved to 1.47 amongst women whose infants had a frenotomy. Conclusion: Our study suggests that performing a frenotomy in infants diagnosed with ankyloglossia may positively impact breastfeeding.

We aimed to compare the efficacy of Bifidobacterium longum KABP042 + Pediococcus pentosaceus KABP041 (BL + PP) vs. Limosilactobacillus reuteri DSM17938 (LR) in alleviating the symptoms of infant colic, as commercially available formulations. A randomized, multicenter, parallel, single-blind (investigator) trial was conducted in 112 colicky infants diagnosed as per Rome IV criteria and randomly allocated to receive BL + PP orally (10⁹ colony-forming units [CFU]/day, n = 55) or LR (10⁸ CFU/day, n = 57) for 21 days. Primary study outcomes were percentage of responders (≥ 50% reduction in crying and fussing time from baseline, as reported by parents in a structured diary) and daily crying and fussing time (minutes/day) on days 7, 14, and 21 after randomization. Study groups were comparable at baseline. Responder rate was significantly higher in BP + PP group vs. LR group at days 7 (61.1% vs. 37.5%, p = 0.013) and 14 (84.6% vs. 59.3%, p = 0.004). Crying and fussing time (median [IQR]) became significantly lower in BL + PP group vs. LR group on day 7 (119 [60-210] vs. 180 [110-270]; p = 0.028), day 14 (60.0 [30-105] vs. 120 [60-180]; p = 0.017), and day 21 (29 [0-85] vs. 67 [30-165]; p = 0.011). No significant differences were found in the number of adverse events between the groups.

Conclusion: The specific formulation of B. longum KABP042 and P. pentosaceus KABP041 achieved a higher response rate and a larger reduction in crying and fussing time in colicky infants. Both probiotic interventions were well tolerated.

Trial registration: The study was retrospectively registered as NCT05271747 on February 28th, 2022.

What is known: • L. reuteri DSM17938 (LR) is the most researched probiotic strain for infant colic against placebo in randomized, controlled clinical trials, and is recommended in various guidelines. A novel probiotic combining strains B. longum KABP042 and P. pentosaceus KABP041 (BL + PP) has also demonstrated efficacy in infant colic against placebo.

What is new: • This randomized study provides the first direct comparison of two probiotics for infant colic. BL + PP seems to be superior to LR in reducing crying time.

Octreotide is recommended as a second-line treatment for patients with congenital hyperinsulinism (CHI), especially for those who do not respond to diazoxide or surgical intervention. Studies on the adverse effects of octreotide in large cohorts are still scarce. We evaluated the safety of octreotide in CHI patients by reviewing cases from the two largest centres in China that specialize in the management of this condition. Our study analysed adverse events in 122 CHI patients on octreotide, with a 93% success rate for the therapy alone. The mean maximum dose of octreotide was 13.1 ± 6.5 µg/kg/day, with no difference in required doses between diffuse and focal lesion patients. Common side effects were hepatobiliary injuries (20.5%), gastrointestinal symptoms (31.1%), and transient hyperglycaemia (49.2%), with one case of necrotizing enterocolitis. Adverse event rates increased in patients treated with intermediate octreotide dose to those treated with higher doses, rising from 58% at doses of 5-10 µg/kg/day to 100% at doses exceeding 20 µg/kg/day. Patients experiencing adverse events received significantly higher doses.

Conclusion: Octreotide effectively maintained blood glucose levels in diazoxide-unresponsive CHI patients without serious adverse effects, across all subtypes. Our study suggests that intermediate octreotide dosing is associated with a lower incidence of adverse events. We recommend close monitoring of patients receiving octreotide, especially during the initiation phase and when higher doses are administered.

What is known: • Octreotide is a commonly used second line treatment for patients with congenital hyperinsulinism. • The administration of octreotide is frequently associated with gastrointestinal adverse events.

What is new: • Our study indicates that octreotide is used without serious adverse effects to maintain blood glucose levels in infants with congenital hyperinsulinism who are otherwise in good health. • The incidence of adverse events in patients treated with octreotide is dose-dependent.

We aimed to analyze the effect of video laryngoscopy on intubation success, time to intubation, and adverse events in infants and neonates. A systematic review and meta-analysis was performed, for which a neonates (age less than 29 days) and infants (age less than 365 days) needing to be intubated were included. The main outcomes were first attempt success rate in the intubation, time to intubation, and adverse events. Evidence certainty was assessed according to GRADE. We included 13 studies. Seven studies with 897 patients focused on neonates, and the first attempt success rate was higher in the video laryngoscopy group (RR 1.18, CI: 1.03-1.36). Six studies included 1039 infants, and the success rate was higher in the video laryngoscopy group (RR 1.06, CI: 1.00-1.20). Time to intubation was assessed in 11 trials, and there was no difference between the groups (mean difference 1.2 s, CI - 2.2 s to + 4.6 s). Odds of desaturation (OR 0.62, CI 0.42-0.93) and nasal/oral trauma (OR 0.24, CI 0.07-0.85) were lower in the video laryngoscopy group. Evidence certainties varied between moderate and low.

Conclusion: We found moderate certainty evidence that the use of video laryngoscopy improves first attempt success rates in neonate and infant intubations, while the time to intubation did not differ between video and direct laryngoscopy groups. Further studies are still needed to improve the first intubation success rates in neonates.

What is known: • Video laryngoscopy has been shown to improve first-pass intubation success rates and reduce time to intubation in adults and older children.

What is new: • Video laryngoscopy improved the first attempt intubation success rates both in neonates and in infants. • Video laryngoscopy did not increase the time to intubation, and it was associated with less adverse events than direct laryngoscopy.

Objects: Preterm infants are at an increased risk of developing feeding intolerance (FI) due to the functional immaturity of their gastrointestinal tract. Recent studies and meta-analyses have shown a significant role of bovine lactoferrin (LF) in the management of feeding intolerance and sepsis. This study aimed to assess the effects of oral bovine LF supplementation on FI in preterm infants (26-34 weeks gestational age) and its effect on intestinal permeability measured by serum zonulin concentrations.

Methods: A randomized controlled double-blind interventional pilot study was conducted in the Neonatal Intensive Care Unit (NICU) of Mansoura University. Sixty preterm neonates with FI were included in the study and were randomly assigned into two groups: lactoferrin group (100 mg/day bovine LF for 4 weeks or until discharge) and control group.

Results: The time needed to achieve full enteral feeding of sixty preterm infants (26-34 weeks gestational age) (9 vs. 15 days, P = 0.001) was significantly shorter and serum zonulin concentrations at end of the trial or discharge (3.38 vs. 5.49 ng/ml, P = 0.04) were significantly lower in the lactoferrin group compared with the control group.

Conclusion: Oral bovine lactoferrin given to preterm infants (26-34 weeks gestational age) is associated with improvement of feeding intolerance and decreased intestinal permeability.

Trial registration: This study was registered at clinical trials.gov with ID (NCT04738058) at 2 March 2021.

To evaluate pulmonary hemodynamics in patients who had been followed up for bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) in the mid-term by right heart catheterization (RHC). A retrospective study was conducted among 56 patients who were born at a gestational age < 28 weeks during 2018-2020, and the consecutive patients complicated by BPD and ultrasound-defined PH (n = 10, 18%), of whom 7 patients were treated with sildenafil, were examined by RHC in the mid-term follow-up (median age: 25 months [IQR: 19-32]). Ultrasound study at RHC showed improvement in PH as represented by left ventricular end-systolic eccentricity index (median [IQR], 1.05 [IQR: 1.03-1.06] vs. 1.18 [IQR: 1.15-1.33]), pulmonary artery acceleration time (PAAT) (mean ± SD, 97.3 ± 18.2 vs. 55.2 ± 10.1) and a ratio of PAAT to right ventricular ejection time (0.35 ± 0.05 vs. 0.25 ± 0.04) compared with those at 40 weeks of postmenstrual age (PMA) (p < 0.05, respectively). RHC (mean pulmonary artery [PA] pressure: 21 [19-22] mmHg; pulmonary vascular resistance index [PVRi]: 2.63 [1.95-2.94] Wood Units·m²) revealed that 5 infants (50%) had mild PH (21-24 mmHg) and reduced peripheral PAs by pulmonary wedge angiography. The presence of emphysema on chest CT at 40 weeks of PMA and moderate/marked reduction of contrast filling in peripheral PAs on angiography were correlated with increased PVRi (p < 0.05, respectively).

Conclusion: We observed that even after apparent resolution of ultrasound-defined PH, half of patients had catheterization-defined PH and vasculopathy at 2 years of age. These findings warrant long-term follow-up studies of BPD-associated PH.

What is known: • Pulmonary hypertension (PH) is associated with increased mortality in infants with bronchopulmonary dysplasia (BPD). Mortality in patients with BPD-associated PH predominantly occurs within the first 6 months of life and most patients who survive beyond 6 months show resolution of PH on echocardiography by 2 to 3 years of age.

What is new: • Even after the resolution of echocardiography-derived PH in infants with BPD-associated PH in the mid-term, the majority of such patients have abnormal pulmonary vasculature with PH or mildly elevated pulmonary artery pressure on right heart catheterization (RHC), indicating that echocardiography is insufficient and RHC may be necessary to follow up this population of patients.