Frontiers in Pediatrics最新文献

Background: Intraventricular Hemorrhage (IVH) is one of the common and serious complications of Very Low Birth Weight Infant (VLBW) that may lead to long-term neurodevelopmental deficits. Although several studies have been conducted to explore its risk factors, the results have been inconsistent. The aim of this study was to identify the major risk factors for intraventricular Hemorrhage in VLBW by systematic evaluation and Meta-analysis of the available evidence.

Methods: PubMed, Web of Science, Embase, Cochrane Library were systematically searched, and observational studies (case-control and cohort studies) were included from the time of library construction to 20 January 2025, and the literature that met the criteria were screened and relevant data were extracted. Meta-analysis was performed using Stata 15.0 software to assess the combined odds ratio (OR) and 95% confidence interval (CI) for each risk factor.

Results: A total of 21 studies included 6 case-control studies, 15 cohort studies, involving a total of 13,800 patients, The results of the meta-analysis showed that hypotension [OR = 3.64, 95%CI (1.87, 7.08)], patent ductus arteriosus (PDA) [OR = 1.86, 95%CI (1.46, 2.36)], vaginal delivery [OR = .10, 95%CI (1.61, 2.72)], neonatal thrombocytopenia[OR = 2.43, 95%CI (1.79, 3.30)], pulmonary hemorrhage [OR = 2.45, 95%CI (1.43, 4.20)], mechanical [OR = 2.09, 95%CI (1.40, 3.10)], sepsis[OR = 2.28, 95%CI (1.77, 2.95)] were a risk factor for the development of IVH in VLBW. While antenatal corticosteroids [OR = 0.68, 95%CI (0.55, 0.84)] was a protective factor for the development of IVH in VLBW.

Conclusion: This study indicates that hypotension, patent ductus arteriosus (PDA), antenatal corticosteroid use, vaginal delivery, neonatal thrombocytopenia, pulmonary hemorrhage, mechanical ventilation, and sepsis constitute the primary risk factors for IVH in VLBW infants. Although these factors exhibit strong clinical associations, current understanding of IVH pathogenesis remains largely dependent on preclinical studies. Integrating clinical and preclinical evidence facilitates a more comprehensive understanding of IVH etiology and informs early intervention strategies.

Systematic review registration: identifier CRD42025633474.

Background: This multicenter study investigated the association between birthweight discordance (BWD) and extrauterine growth restriction (EUGR) in preterm twins, and evaluated the modifying role of small for gestational age (SGA).

Methods: Data from 2,496 infants (1,248 twin pairs) admitted to 22 Chinese NICUs (2018-2020) were analyzed. BWD was calculated as the percentage difference in birthweight between larger and smaller twins, categorized into four groups (≤15%, 15%-20%, 20%-25%, >25%). EUGR was defined as discharge weight below the 10th percentile for corrected gestational age and sex (Fenton's chart). A generalized linear mixed model was employed to analyze the association between BWD and EUGR. Modification analysis was performed to assess the effect of SGA on this association.

Results: BWD of >25% was associated with a significantly increased risk of EUGR compared to BWD ≤15% (adjusted OR = 1.59, 95% CI: 1.05-2.41). Stratified analysis revealed a consistent association in SGA infants (OR = 1.38, 95% CI: 1.30-1.47).

Conclusion: Findings highlight BWD as a critical risk factor for EUGR, particularly in SGA twins. This association suggests that future research should investigate whether tailored monitoring and nutritional interventions in NICUs could help mitigate these growth disparities.

Objective: The current diagnostic and prognostic assessment of congenital diaphragmatic hernia (CDH) in neonates remains challenging. This study aimed to evaluate the utility of neonatal ultrasonography in the diagnosis and prognostic prediction of CDH in infants.

Materials and methods: A retrospective analysis was conducted on clinical data from 152 infants diagnosed with CDH and admitted to the Department of Neonatal Surgery at Children's Hospital between 2017 and 2023. The cohort included 86 (56.6%) males and 66 (43.4%) females. Multivariate logistic regression was employed to identify factors associated with CDH prognosis. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of significant ultrasonographic indicators.

Results: Multivariate logistic regression identified four factors as significant predictors of mortality: diaphragmatic defect length >4 cm [odds ratio [OR] = 2.41, 95% confidence interval [CI]: 1.08-10.58], the presence of hepatic herniation (OR = 2.61, 95% CI: 1.16-5.87), absence of a hernial sac (OR = 4.86, 95% CI: 2.00-11.76), and concomitant lung ultrasound abnormalities (OR = 10.86, 95% CI: 1.28-21.85). The combination of these four parameters demonstrated strong predictive performance for mortality, with an area under the ROC curve of 0.860 (95% CI: 0.786-0.935).

Conclusion: Diaphragmatic defect length, hepatic herniation, hernial sac status, and lung ultrasound findings serve as valuable prognostic indicators in infants with CDH. Integrating these four parameters enhances prognostic accuracy and may support clinical decision-making.

Background: The incidence of obstructive sleep apnea (OSA) in children has increased in recent years. Many primary hospitals have not polysomnography which can diagnose OSA. To investigate the lowest blood oxygen saturation at night (LSaO₂) combine with obstructive sleep apnea 18 items survey (OSA-18) scale to initially screen the sleep status of children with OSA.

Methods: A retrospective study of 189 children aged 4-12 years with sleep-disordered breathing was conducted. All children were monitored using polysomnography and divided into the simple snoring and OSA groups (mild, moderate, and severe). Their parents completed the OSA-18 scale. Correlation among three indices [LSaO2, OSA-18 scale, and obstructive apnea hypoventilation index (OAHI)] was assessed. Subsequently, series and parallel tests were used to understand the sensitivity and specificity of diagnosis.

Results: There was no statistical differences in sex (P = 0.909) and age (P = 0.894), and a significant difference in OSA-18 scores between the simple snoring and OSA groups (P = 0.014) but not in the LSaO2 (P = 0.409). OSA-18 and LSaO2 scores of the mild, moderate, and severe groups were significantly different (P < 0.05), and LSaO2 was correlated with the OAHI. Use of the OSA-18 scale combined with LSaO2 to assess the boundary value of mild and moderate-to-severe OSA was better than that of each index independently. The sensitivity and specificity the parallel test were 85.7% and 62.7%, respectively, can better predict OSA than series test.

Conclusion: The OSA-18 scale combined with LSaO2 has diagnostic value for the diagnosis of OSA, and can be used as a prediction tool for OSA.

Background: Breastfeeding promotion is a cornerstone of neonatal nursing, as it plays a pivotal role in safeguarding the health and fostering the development of newborns. This study aimed to assess neonatal nurses' Knowledge, Attitudes, and Practices (KAP) regarding breastfeeding for hospitalized neonates and identify factors influencing these domains.

Methods: A cross-sectional survey was conducted among neonatal nurses between July 1 and August 30, 2025. Eligible nurses were recruited via a rigorous screening process, and data were collected using a validated KAP scale. Benjamini-Hochberg false discovery rate (FDR) adjustment addressed multiple comparison biases, and comprehensive regression assumption checks (multicollinearity, residual normality, homoscedasticity) were performed to ensure result validity.

Results: A total of 122 neonatal nurses were included. Based on predefined scoring benchmarks (Low: ≤90; Moderate: 91-140; High: ≥141), participants demonstrated a moderate level of overall breastfeeding-related KAP (mean ± SD: 134.28 ± 14.02). Hierarchical regression analysis revealed: (1) Knowledge was significantly predicted by age (β = 0.304, p = 0.017), years of clinical experience (β = 0.433, p = 0.040), educational level (β = 0.385, p = 0.015), and specialized breastfeeding training (β = 0.402, p = 0.007); (2) Attitudes were significantly influenced by number of children (β = 0.224, p = 0.018), professional title (β = 0.196, p = 0.002), and specialized training (β = 0.264, p = 0.001); (3) Practices were significantly associated with years of clinical experience (β = 0.380, p = 0.028), professional title (β = 0.504, p = 0.011), educational level (β = 0.436, p = 0.020), and specialized training (β = 0.329, p = 0.001). Specialized breastfeeding training emerged as a consistent positive predictor across all KAP dimensions (medium effect sizes), explaining 56.0%-63.6% of the variance in the models (adjusted R ²).

Conclusion: Neonatal nurses exhibited positive attitudes but moderate knowledge and practice levels regarding breastfeeding, with targeted gaps in evidence-based care and parental education. These findings highlight the need for tailored training programs-prioritizing younger nurses, those with less experience, lower educational/professional titles, and untrained individuals-to enhance breastfeeding-related competence.

Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by biallelic loss-of-function variants of the survival motor neuron 1 (SMN1) gene on chromosome 5q13. It has been reported that SMA may affect the function of the kidneys. Here, we report a patient with co-occurrence of SMA and IgA nephropathy (IgAN).

Case presentation: A 14-year-old girl presented with six months of limb weakness, progressive exacerbation of symptoms of left lower limb muscle weakness; her left lower limb muscle strength decreased, and bilateral knee tendon reflexes and Achilles tendon reflexes were not elicited. The patient was diagnosed with SMA type 3 in conjunction with the results of genetic testing. The patient had proteinuria and hematuria, and a renal biopsy was performed. Considering the patient's clinical and pathological characteristics, the final diagnosis was spinal muscular atrophy combined with IgA nephropathy. To the best of our knowledge, this is the first reported case that demonstrates the coexistence of SMA and IgAN.

Discussion and conclusions: The exact mechanism of renal impairment due to SMA is not fully understood, and the combination of SMA with IgAN is extremely rare. Our report suggests that there may be a potential association between them.

Intravascular papillary endothelial hyperplasia (IPEH), or Masson's tumor, is a rare, benign vascular lesion that can closely resemble malignant vascular tumors. While primarily diagnosed in adulthood, pediatric cases are uncommon, and no prenatal diagnoses have been reported to date. Here, we present the first documented prenatal presentation of fetal intracranial IPEH detected in utero at 34 weeks of gestation. This case highlights the importance of considering IPEH in the differential diagnosis of fetal intracranial masses and underscores the role of early prenatal detection in optimizing perinatal and surgical management.

Objective: To explore the clinical characteristics of neonatal late-onset sepsis (LOS) and analyze the independent risk factors for secondary neonatal purulent meningitis (NPM).

Methods: This retrospective case-control study included infants diagnosed with LOS at the Children's Hospital of Soochow University between January 2018 and December 2023. The study divided the patients into two groups: the NPM group and the non-NPM group, based on the presence of secondary purulent meningitis. Clinical characteristics, laboratory markers, pathogen distribution, and treatment regimens were compared between the two groups. Independent risk factors were identified through multivariable logistic regression analysis, and a receiver operating characteristic (ROC) curve was used to evaluate the predictive performance.

Results: A total of 453 LOS patients were included, with 98 (21.6%) cases in the NPM group. Compared to the non-NPM group, the NPM group exhibited a higher frequency of prolonged fever (>3 days), fever peak >39 °C, tachypnea, seizures, irritability, poor feeding, and bulging anterior fontanel (all P < 0.05). Laboratory tests showed elevated procalcitonin (PCT) in the NPM group, while albumin, cholinesterase, glycocholic acid, and creatine kinase (CK) levels were decreased (all P < 0.05). Blood culture results revealed that the NPM group had a significantly higher proportion of non-Group B Streptococcus and Enterobacter cloacae, but a lower proportion of Staphylococcus aureus (P < 0.05). Multivariable analysis identified prolonged fever (>3 days), fever peak >39 °C, tachypnea, PCT >10.50 ng/mL, and CK <200 U/L as independent risk factors for LOS complicated by NPM. ROC analysis showed that the combined prediction model had an AUC of 0.804 (95% CI: 0.751-0.856), with a sensitivity of 75.24% and specificity of 72.83%, which outperformed the individual predictors for predicting NPM.

Conclusion: Prolonged high fever, abnormal respiration, elevated PCT, and decreased CK levels are important independent predictors of LOS complicated by NPM. The combined prediction model demonstrates high diagnostic efficacy, providing a useful reference for early identification of high-risk infants and the development of personalized intervention strategies.