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Improving water competency among children on the autism spectrum: the AquOTic randomized controlled trial. 提高自闭症儿童的水中能力:AquOTic 随机对照试验。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1473328
Erika Kemp, Melica Nikahd, Mequeil Howard, Amy Darragh, Jewel E Crasta

Introduction: There is a critical need for evidence-based and manualized interventions targeting water competency including swim and water safety skills tailored to meet the needs of children on the autism spectrum, a group that is at a high risk of drowning. This study examined the efficacy of AquOTic-a 10-week occupational therapy-based aquatic intervention to improve water competency among children on the autism spectrum.

Methods: A total of 37 children on the autism spectrum (ages 5-9 years) were randomized to a waitlist control group (n = 24) or AquOTic intervention group (n = 37; 28 males). Blinded assessors administered the standardized Water Orientation Test-Alyn (WOTA) 1 and 2 and a Swim Skills Checklist to all participants pre- and post-AquOTic/control. Repeated measures mixed effects models were used to examine intervention effects.

Results: Average WOTA 1 scores increased significantly after participants received AquOTic (Δ = 5.7; 95% CI: 3.7-7.8; p < 0.001), and average WOTA 2 scores increased significantly after participants received AquOTic (Δ = 9.0; 95% CI: 5.7-12.3; p < 0.001). Average swim skills increased significantly after participants received AquOTic (Δ = 7.6; 95% CI: 5.3, 10.0; p < 0.001).

Conclusion: Our results highlight the efficacy of AquOTic to improve water competency among children on the autism spectrum. Further research is needed to examine long-term effects, dosage requirements to achieve water competency, and the impact of aquatic therapy on other health outcomes.

Clinical trials registration: clinicaltrials.gov, NCT05524753.

导言:自闭症谱系儿童是溺水的高危人群,他们的游泳和水上安全技能等水上能力需要循证和人工干预。本研究考察了 AquOTic(一种为期 10 周、以职业疗法为基础的水上干预方法)对提高自闭症谱系儿童水上能力的效果:共有 37 名自闭症谱系儿童(5-9 岁)被随机分配到候补对照组(24 人)或 AquOTic 干预组(37 人;28 名男性)。盲人评估员在水上定向训练/对照组前后对所有参与者进行了标准化的水上定向测试-Alyn(WOTA)1 和 2 以及游泳技能检查表。采用重复测量混合效应模型来检验干预效果:结果:参与者接受 AquOTic 后,WOTA 1 平均得分显著提高(Δ = 5.7;95% CI:3.7-7.8;p p p 结论:我们的结果突出表明了 AquOTic 的疗效:我们的研究结果表明,AquOTic 能有效提高自闭症谱系儿童的水中能力。还需要进一步研究长期效果、达到水中能力的剂量要求以及水中疗法对其他健康结果的影响。临床试验注册:clinicaltrials.gov,NCT05524753。
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引用次数: 0
First postnatal lactate blood levels on day 1 and outcome of preterm infants with gestational age <29 weeks. 胎龄小于 29 周的早产儿出生后第 1 天的首次乳酸血浓度与预后。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1443066
Stephanie Zipf, Ingmar Fortmann, Christoph Härtel, Oliver Andres, Eric Frieauff, Pia Paul, Anna Häfke, Heiko Reutter, Patrick Morhart, Ursula Weller, Amrei Welp, Henry Kipke, Egbert Herting, Alexander Humberg, Wolfgang Göpel, Kathrin Hanke

Background: Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks.

Methods: We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22-28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models.

Results: First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2-27.9] weeks and birth weight of 840 g [IQR 665-995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03-1.37; p = 0.002) and BPD (OR 1.23; 95% CI 1.06-1.43; p = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54-0.85; p = 0.001).

Conclusions: In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.

背景:血清乳酸水平被用作围产期窒息的生物标志物,但其对早产儿预后的价值尚不确定。本观察性研究旨在确定出生后第 1 天血清乳酸水平与妊娠周数小于 29 周的早产儿短期预后的关系:我们分析了德国新生儿网络(GNN)早产儿人群队列中的数据,这些早产儿在 2009 年 4 月 1 日至 2020 年 12 月 31 日期间的胎龄(GA)为 22-28 周,出生后首次乳酸水平可用。我们假设,以 mmol/L 为单位的高乳酸水平会增加 VLBW 婴儿发生脑室内出血(IVH)和支气管肺发育不良(BPD)的风险,而与小胎龄(SGA)状态无关。通过单变量分析和多元逻辑回归模型对假设进行了评估:结果:2499 名婴儿获得了产后首次乳酸水平。研究对象的中位孕期为 26.7 [IQR 25.2-27.9]周,出生体重为 840 克 [IQR 665-995]。与未受影响的婴儿相比,患有 IVH 和 BPD 等短期并发症的婴儿的初始乳酸水平较高。乳酸临界值为 4 mmol/L 时,对 IVH 的阳性预测值为 0.28,对 BPD 的阳性预测值为 0.30。在对已知混杂变量进行调整后,第 1 天乳酸水平每增加 1 mmol/L 与 IVH(OR 1.18;95% CI 1.03-1.37;p = 0.002)和 BPD(OR 1.23;95% CI 1.06-1.43;p = 0.005)风险的适度增加有关,但与败血症或死亡率无关。值得注意的是,SGA 与任何等级和严重 IVH 的较低风险相关(OR 0.70;95% CI 0.54-0.85;p = 0.001):结论:在我们的观察性队列研究中,无论是否为SGA,初始乳酸水平越高与不良预后越相关。结论:在我们的观察性队列研究中,无论 SGA 状况如何,较高的初始乳酸水平与不良预后相关。然而,乳酸临界水平(如 4 mmol/L)的预测价值较低。
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引用次数: 0
Paediatric rheumatology in Nigeria: history, challenges and the future. 尼日利亚儿科风湿病学:历史、挑战与未来。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1440625
Ayodele Faleye

Pediatric rheumatology is a relatively new subspecialty in Nigeria. For many years, rheumatic disease had not been well-recognized or studied in Nigeria, so there has been a low suspicion index. The clinical presentation of most pediatric rheumatic diseases (PRDs) mimics non-rheumatic diseases making it a diagnostic challenge most of the time. The story has changed in Lagos since the creation of a pediatric rheumatology unit at the Lagos State University Teaching Hospital. There is now a high index of suspicion for these diseases in the hospital but no one knows about what is happening in the other 35 states of the country who do not have a pediatric rheumatologist. Major challenges being faced presently are poor awareness among healthcare workers and the community, high cost of investigations and medications, lack of pediatric rheumatologists in most hospitals in the country, lack of pediatric rheumatology training centers for both undergraduate and postgraduate training, and lack of research data. The healthcare community in Nigeria is looking forward to a future where pediatric rheumatology will be highly recognized and established.

小儿风湿病学在尼日利亚是一个相对较新的亚专科。多年来,风湿病在尼日利亚一直未得到充分认识或研究,因此怀疑指数较低。大多数小儿风湿病(PRDs)的临床表现都与非风湿性疾病相似,因此在大多数情况下都是诊断难题。自从拉各斯州立大学教学医院(Lagos State University Teaching Hospital)成立了小儿风湿病科后,拉各斯的情况发生了变化。现在,该医院对这些疾病的怀疑指数很高,但没有人知道全国其他 35 个没有儿科风湿病医生的州的情况如何。目前面临的主要挑战包括:医护人员和社区的认识不足、检查和药物费用高昂、国内大多数医院缺乏小儿风湿病专家、缺乏小儿风湿病培训中心进行本科生和研究生培训以及缺乏研究数据。尼日利亚医疗界期待着未来儿科风湿病学能够得到高度认可和建立。
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引用次数: 0
Case Report: Reiterating the importance of tissue biopsy in the diagnosis of tuberculosis: lessons from a case of pediatric pulmonary tuberculosis complicated by Hodgkin's lymphoma. 病例报告:重申组织活检在肺结核诊断中的重要性:从一例并发霍奇金淋巴瘤的小儿肺结核病例中汲取的教训。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1454657
Yonghan Luo, Xiaotao Yang, Jun Zhou, Shuangqiong Pu, Yanchun Wang

The clinical symptoms of tuberculosis infection in children are not typical and need to be distinguished from many diseases, and the tumor is one of them. We present a case of cervical lymphadenopathy in a child with positive purified protein derivative (PPD) and Interferon-Gamma Release Assay results, ultimately diagnosed with Hodgkin's lymphoma via cervical lymph node biopsy. We learned some lessons from the case: First, Pathological biopsy remains the "gold standard" for diagnosing tuberculosis. Second, there are limitations of sampling in lump fine needle aspiration biopsy, surgical methods for lymph node are preferred to obtain larger tissues and improve tuberculosis detection sensitivity.

儿童结核感染的临床症状并不典型,需要与多种疾病相鉴别,肿瘤就是其中之一。我们介绍了一例颈部淋巴结肿大的患儿,其纯化蛋白衍生物(PPD)和干扰素-γ释放测定结果均为阳性,最终通过颈部淋巴结活检确诊为霍奇金淋巴瘤。我们从这个病例中吸取了一些教训:首先,病理活检仍是诊断结核病的 "金标准"。其次,肿块细针穿刺活检取样存在局限性,最好采用手术方法进行淋巴结活检,以获取更大的组织,提高结核病检测灵敏度。
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引用次数: 0
Analysis of electrode performance on amplitude integrated electroencephalography in neonates: evaluation of a new electrode aCUP-E vs. liquid gel electrodes. 新生儿振幅综合脑电图的电极性能分析:新型电极 aCUP-E 与液体凝胶电极的对比评估。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1452862
Albert Fabregat-Sanjuan, Ángel Rodríguez-Ballabriga, Agnès Rigo-Vidal, Rosa Pàmies-Vilà, Susana Larrosa-Capaces, Vanesa Rius-Costa, Vicenç Pascual-Rubio

Background: Neonatologists and clinical neurophysiologists face challenges with the current electrodes used for long-duration amplitude-integrated electroencephalography (aEEG) in neonatal intensive care units (NICU), limiting the capacity to diagnose brain damage.

Objectives: The objectives of this study were to develop methods for comparing the performance of different electrodes to be used in aEEG. The comparison was done between a newly designed neonate-specific electrode, aCUP-E, with commercial liquid gel electrodes used in amplitude-integrated electroencephalography (aEEG). The comparison included impedance stability, electrode survival, recording quality, usability, and satisfaction of NICU staff.

Methods: aEEG recordings with bipolar montage was used, with one hemisphere fitted with commercial electrodes and the other with aCUP-E electrodes, alternated among subjects. Continuous impedance and raw EEG data were collected over a minimum of 24 h, and signal processing was performed using Python and MATLAB.

Main results: aCUP-E electrodes demonstrated superior performance, including: Increased impedance stability and electrode survival, enhanced recording quality with fewer artifacts, high correlation in signal capture between electrodes during optimal brain activity segments, higher signal-to-noise ratio (SNR) across varying impedance levels, greater staff satisfaction and ease of use. Moreover, Kaplan-Meier curves indicated a higher survival rate for aCUP-E electrodes over 24 h compared to commercial electrodes. Impedance variability analysis showed statistically significant stability improvements for aCUP-E.

Conclusion: aCUP-E electrodes outperform commercial liquid gel electrodes in impedance stability, electrode survival, and recording quality. These results suggest that aCUP-E electrodes could significantly enhance aEEG utilization in diagnosing and treating neonatal brain conditions in NICUs. Future improvements to the aCUP-E electrode may further reduce artifacts and increase electrode longevity, potentially leading to a significant improvement in neonatal brain monitoring by means of aEEG.

背景:新生儿学家和临床神经电生理学家面临着新生儿重症监护室(NICU)中目前用于长时间振幅积分脑电图(aEEG)的电极所带来的挑战,这限制了诊断脑损伤的能力:本研究的目的是开发用于比较不同脑电图电极性能的方法。比较对象是新设计的新生儿专用电极 aCUP-E 和用于振幅积分脑电图 (aEEG) 的商用液体凝胶电极。比较内容包括阻抗稳定性、电极存活率、记录质量、可用性和新生儿重症监护室工作人员的满意度。方法:使用双极蒙太奇进行 aEEG 记录,一个半球安装商用电极,另一个半球安装 aCUP-E 电极,受试者交替使用。连续收集阻抗和原始脑电图数据至少 24 小时,并使用 Python 和 MATLAB 进行信号处理:主要结果:aCUP-E 电极表现出卓越的性能,包括:阻抗稳定性和电极存活率提高;记录质量提高,伪影减少;在最佳脑部活动区段,电极之间的信号捕获具有高度相关性;不同阻抗水平的信噪比(SNR)更高;工作人员的满意度更高,且易于使用。此外,Kaplan-Meier 曲线显示,与商用电极相比,aCUP-E 电极在 24 小时内的存活率更高。结论:aCUP-E 电极在阻抗稳定性、电极存活率和记录质量方面均优于商用液体凝胶电极。这些结果表明,aCUP-E 电极可大大提高 aEEG 在新生儿重症监护室诊断和治疗新生儿脑部疾病方面的应用。未来对 aCUP-E 电极的改进可能会进一步减少伪影并延长电极寿命,从而有可能显著改善通过 aEEG 监测新生儿脑部的工作。
{"title":"Analysis of electrode performance on amplitude integrated electroencephalography in neonates: evaluation of a new electrode aCUP-E vs. liquid gel electrodes.","authors":"Albert Fabregat-Sanjuan, Ángel Rodríguez-Ballabriga, Agnès Rigo-Vidal, Rosa Pàmies-Vilà, Susana Larrosa-Capaces, Vanesa Rius-Costa, Vicenç Pascual-Rubio","doi":"10.3389/fped.2024.1452862","DOIUrl":"https://doi.org/10.3389/fped.2024.1452862","url":null,"abstract":"<p><strong>Background: </strong>Neonatologists and clinical neurophysiologists face challenges with the current electrodes used for long-duration amplitude-integrated electroencephalography (aEEG) in neonatal intensive care units (NICU), limiting the capacity to diagnose brain damage.</p><p><strong>Objectives: </strong>The objectives of this study were to develop methods for comparing the performance of different electrodes to be used in aEEG. The comparison was done between a newly designed neonate-specific electrode, aCUP-E, with commercial liquid gel electrodes used in amplitude-integrated electroencephalography (aEEG). The comparison included impedance stability, electrode survival, recording quality, usability, and satisfaction of NICU staff.</p><p><strong>Methods: </strong>aEEG recordings with bipolar montage was used, with one hemisphere fitted with commercial electrodes and the other with aCUP-E electrodes, alternated among subjects. Continuous impedance and raw EEG data were collected over a minimum of 24 h, and signal processing was performed using Python and MATLAB.</p><p><strong>Main results: </strong>aCUP-E electrodes demonstrated superior performance, including: Increased impedance stability and electrode survival, enhanced recording quality with fewer artifacts, high correlation in signal capture between electrodes during optimal brain activity segments, higher signal-to-noise ratio (SNR) across varying impedance levels, greater staff satisfaction and ease of use. Moreover, Kaplan-Meier curves indicated a higher survival rate for aCUP-E electrodes over 24 h compared to commercial electrodes. Impedance variability analysis showed statistically significant stability improvements for aCUP-E.</p><p><strong>Conclusion: </strong>aCUP-E electrodes outperform commercial liquid gel electrodes in impedance stability, electrode survival, and recording quality. These results suggest that aCUP-E electrodes could significantly enhance aEEG utilization in diagnosing and treating neonatal brain conditions in NICUs. Future improvements to the aCUP-E electrode may further reduce artifacts and increase electrode longevity, potentially leading to a significant improvement in neonatal brain monitoring by means of aEEG.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of probiotics on the prevention and treatment of children with allergic rhinitis: a meta-analysis of randomized controlled trials. 益生菌对预防和治疗儿童过敏性鼻炎的效果:随机对照试验荟萃分析。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1352879
Xinyi Luo, Huan Wang, Huixia Liu, Yue Chen, Li Tian, Qing Ji, Dengpiao Xie

Background and aim: Recent studies have demonstrated the anti-allergic effects of probiotics in humans. However, their role in preventing and treating pediatric allergic rhinitis has not been thoroughly investigated. This study aimed to systematically review the efficacy and preventive effects of probiotics on pediatric allergic rhinitis.

Methods: We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science databases for all relevant studies on probiotics and pediatric allergic rhinitis. Studies meeting the inclusion criteria were included, data were extracted, and meta-analyses were performed.

Results: A total of 28 studies with 4,765 participants were included in this study. The pooled results showed that the use of probiotics was associated with a significant improvement in total nose symptom scores (SMD, -2.27; 95% CI, -3.26 to -1.29; P < 0.00001), itchy nose scores (SMD, -0.44; 95% CI, -0.80 to -0.07; P = 0.02), sneezing scores (SMD, -0.47; 95% CI, -0.84 to -0.10; P = 0.01), eye symptoms (SMD, -3.77; 95% CI, -5.47 to -2.07; P < 0.00001), and Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (SMD, -2.52; 95% CI, -4.12 to -0.92; P < 00001). However, the use of probiotics was not associated with the incidence of allergic rhinitis (RR, 0.9; 95% CI, 0.74-1.08; P = 0.26).

Conclusions: The present study demonstrated that probiotics were effective and safe for improving pediatric allergic rhinitis symptoms and quality of life. However, probiotics could not prevent pediatric allergic rhinitis.

背景和目的:最近的研究表明,益生菌对人类具有抗过敏作用。然而,它们在预防和治疗小儿过敏性鼻炎方面的作用尚未得到深入研究。本研究旨在系统回顾益生菌对小儿过敏性鼻炎的疗效和预防作用:我们系统地检索了 PubMed、Embase、Cochrane Central Register of Controlled Trials 和 Web of Science 数据库中所有与益生菌和小儿过敏性鼻炎相关的研究。纳入符合纳入标准的研究,提取数据并进行荟萃分析:结果:本研究共纳入 28 项研究,4,765 人参与。汇总结果显示,使用益生菌可显著改善鼻部症状总分(SMD,-2.27;95% CI,-3.26 至-1.29;P P = 0.02)、打喷嚏得分(SMD,-0.47;95% CI,-0.84 至-0.10;P = 0.01)、眼部症状(SMD,-3.77;95% CI,-5.47 至-2.07;P P = 0.26):本研究表明,益生菌对改善小儿过敏性鼻炎症状和生活质量有效且安全。然而,益生菌并不能预防小儿过敏性鼻炎。
{"title":"Effects of probiotics on the prevention and treatment of children with allergic rhinitis: a meta-analysis of randomized controlled trials.","authors":"Xinyi Luo, Huan Wang, Huixia Liu, Yue Chen, Li Tian, Qing Ji, Dengpiao Xie","doi":"10.3389/fped.2024.1352879","DOIUrl":"https://doi.org/10.3389/fped.2024.1352879","url":null,"abstract":"<p><strong>Background and aim: </strong>Recent studies have demonstrated the anti-allergic effects of probiotics in humans. However, their role in preventing and treating pediatric allergic rhinitis has not been thoroughly investigated. This study aimed to systematically review the efficacy and preventive effects of probiotics on pediatric allergic rhinitis.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science databases for all relevant studies on probiotics and pediatric allergic rhinitis. Studies meeting the inclusion criteria were included, data were extracted, and meta-analyses were performed.</p><p><strong>Results: </strong>A total of 28 studies with 4,765 participants were included in this study. The pooled results showed that the use of probiotics was associated with a significant improvement in total nose symptom scores (SMD, -2.27; 95% CI, -3.26 to -1.29; <i>P</i> < 0.00001), itchy nose scores (SMD, -0.44; 95% CI, -0.80 to -0.07; <i>P</i> = 0.02), sneezing scores (SMD, -0.47; 95% CI, -0.84 to -0.10; <i>P</i> = 0.01), eye symptoms (SMD, -3.77; 95% CI, -5.47 to -2.07; <i>P</i> < 0.00001), and Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (SMD, -2.52; 95% CI, -4.12 to -0.92; <i>P</i> < 00001). However, the use of probiotics was not associated with the incidence of allergic rhinitis (RR, 0.9; 95% CI, 0.74-1.08; <i>P</i> = 0.26).</p><p><strong>Conclusions: </strong>The present study demonstrated that probiotics were effective and safe for improving pediatric allergic rhinitis symptoms and quality of life. However, probiotics could not prevent pediatric allergic rhinitis.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A pilot randomized controlled trial comparing noradrenaline and adrenaline as a first-line vasopressor for fluid-refractory septic shock in neonates. 一项试验性随机对照试验,比较了去甲肾上腺素和肾上腺素作为新生儿液体难治性脓毒性休克的一线血管抑制剂。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1443990
Reema Garegrat, Suprabha Patnaik, Sonali Suryawanshi, Chinmay Chetan, Nishant Banait, Pari Singh, Aditya Kallimath, Naharmal B Soni, Yogen Singh, Pradeep Suryawanshi

Background and study design: Limited data exists on noradrenaline therapy in neonatal septic shock. We compared the efficacy of noradrenaline with adrenaline in neonatal septic shock. This single center, open label, pilot randomized controlled trial included neonates with clinical evidence of sepsis and shock.

Study outcomes: Primary outcomes were: 1) resolution of shock one hour after treatment, and 2) mortality during hospital stay. Secondary outcomes included: need for additional vasopressors; hemodynamic stability without further administration of vasopressors for ≥2 h; changes in blood pressure and heart rate after 1 h of vasopressor treatment; and morbidities during the hospital stay.

Results: Of 65 eligible neonates, 42 were randomized (21 each in adrenaline and noradrenaline treatment arms) between August 2020 and January 2022, at level III neonatal intensive care unit (NICU) of Bharati Vidyapeeth Deemed University Medical College and Hospital (BVDUMCH). The mean (SD) gestational age and mean (SD) birth weight were 36.1(4.2) weeks and 1.8 (0.2) kilograms birth weight for noradrenaline and 36.9 (4.1) weeks and 1.7 (0.7) kilograms for adrenaline. Shock resolved within 1 h of vasopressor therapy in 76.2% neonates in the noradrenaline arm and 61.9% in adrenaline arm (p value-0.53). Mortality during hospital stay was 28.6% (6/21) in noradrenaline group and 33.3% (7/21) in adrenaline group (p value- 0.58). Additional vasopressors were required in 23.8% neonates of the noradrenaline group compared to 38.1% neonates in adrenaline arm (p value-0.53). Median (SD) duration of intensive care stay was 6 (SD) days in the noradrenaline group and 10 (SD) days in the adrenaline group (p value-0.045).

Conclusion: Among neonates with septic shock, the efficacy of noradrenaline was comparable to adrenaline in resolving septic shock after one hour of infusion and on the mortality during hospital stay.

Clinical trial registration: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDI2NTc=&Enc=&userName=noradrenaline, Clinical Trials Registry - India with identifier CTRI/2020/08/027185 (17/08/2020).

背景和研究设计:有关去甲肾上腺素治疗新生儿脓毒性休克的数据有限。我们比较了去甲肾上腺素和肾上腺素对新生儿脓毒性休克的疗效。这项单中心、开放标签、试验性随机对照试验纳入了有脓毒症和休克临床证据的新生儿:主要结果如下研究结果:主要结果包括:1)治疗一小时后休克缓解;2)住院期间死亡率。次要结果包括:是否需要额外使用血管加压剂;在不使用血管加压剂≥2 小时的情况下血液动力学是否稳定;血管加压剂治疗 1 小时后血压和心率的变化;以及住院期间的发病率:2020年8月至2022年1月期间,在巴拉蒂维迪亚皮德大学医学院和医院(BVDUMCH)三级新生儿重症监护病房(NICU)的65名符合条件的新生儿中,42名接受了随机治疗(肾上腺素治疗组和去甲肾上腺素治疗组各21名)。去甲肾上腺素的平均(标清)胎龄和平均(标清)出生体重分别为 36.1(4.2)周和 1.8(0.2)千克,肾上腺素的平均(标清)胎龄和平均(标清)出生体重分别为 36.9(4.1)周和 1.7(0.7)千克。使用去甲肾上腺素的新生儿中有76.2%在使用血管加压疗法后1小时内缓解了休克,使用肾上腺素的新生儿中有61.9%在使用血管加压疗法后1小时内缓解了休克(P值-0.53)。住院期间死亡率,去甲肾上腺素组为 28.6%(6/21),肾上腺素组为 33.3%(7/21)(P 值-0.58)。23.8%的去甲肾上腺素组新生儿需要额外使用血管加压药,而肾上腺素组为38.1%(P值-0.53)。中位(标清)重症监护时间,去甲肾上腺素组为6(标清)天,肾上腺素组为10(标清)天(P值-0.045):在患有脓毒性休克的新生儿中,去甲肾上腺素在输注一小时后缓解脓毒性休克和降低住院期间死亡率方面的疗效与肾上腺素相当。临床试验注册:https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDI2NTc=&Enc=&userName=noradrenaline,印度临床试验注册中心,标识符为CTRI/2020/08/027185(2020年8月17日)。
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引用次数: 0
WWOX-related epileptic encephalopathy caused by a novel mutation in the WWOX gene: a case report. WWOX基因新型突变导致的WWOX相关癫痫性脑病:病例报告。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1453778
Dan Feng, Ye Li, Ya-Ting Zhang, Yan-Jun Song, Dong-Yuan Qin, Fan Wang

Background: WWOX-related epileptic encephalopathy is an autosomal recessive disorder caused by mutations in the WW-containing oxidoreductase gene, characterized by the onset of refractory seizures in infants. Early-onset epilepsy, electroencephalography abnormalities, and developmental delay or degeneration are the main clinical manifestations. Early death can occur in severe cases. In the present study, a novel variant in WWOX was detected in a patient with epilepsy and his healthy parents.

Case presentation: A 5-month-old boy presented with epilepsy. The main manifestations were intractable seizures, mental and motor retardation and hearing impairment. Subsequent genetic testing revealed the presence of an epilepsy-associated novel mutation: c.991C>A (amino acid change: p.Ser304Tyr) in the WWOX gene. Variants were inherited from parents with healthy phenotypes. Finally, a patient died at 6 months of age.

Conclusion: The discovery of novel variants has enriched the existing database of WWOX gene variants and may expand the range of clinical options for treating WWOX-related disorders.

背景:WWOX相关癫痫性脑病是一种常染色体隐性遗传疾病,由含WW的氧化还原酶基因突变引起,以婴儿出现难治性癫痫发作为特征。主要临床表现为早发性癫痫、脑电图异常、发育迟缓或退化。严重病例可出现早期死亡。在本研究中,我们在一名癫痫患者及其健康的父母中发现了一种新的 WWOX 变异:一名 5 个月大的男孩患有癫痫。主要表现为顽固性癫痫发作、智力和运动发育迟缓以及听力障碍。随后的基因检测发现,WWOX 基因中存在一个与癫痫相关的新型突变:c.991C>A(氨基酸变化:p.Ser304Tyr)。变异基因遗传自表型健康的父母。最后,一名患者在 6 个月大时死亡:结论:新型变异体的发现丰富了现有的 WWOX 基因变异体数据库,可能会扩大治疗 WWOX 相关疾病的临床选择范围。
{"title":"<i>WWOX</i>-related epileptic encephalopathy caused by a novel mutation in the <i>WWOX</i> gene: a case report.","authors":"Dan Feng, Ye Li, Ya-Ting Zhang, Yan-Jun Song, Dong-Yuan Qin, Fan Wang","doi":"10.3389/fped.2024.1453778","DOIUrl":"https://doi.org/10.3389/fped.2024.1453778","url":null,"abstract":"<p><strong>Background: </strong><i>WWOX</i>-related epileptic encephalopathy is an autosomal recessive disorder caused by mutations in the WW-containing oxidoreductase gene, characterized by the onset of refractory seizures in infants. Early-onset epilepsy, electroencephalography abnormalities, and developmental delay or degeneration are the main clinical manifestations. Early death can occur in severe cases. In the present study, a novel variant in <i>WWOX</i> was detected in a patient with epilepsy and his healthy parents.</p><p><strong>Case presentation: </strong>A 5-month-old boy presented with epilepsy. The main manifestations were intractable seizures, mental and motor retardation and hearing impairment. Subsequent genetic testing revealed the presence of an epilepsy-associated novel mutation: c.991C>A (amino acid change: p.Ser304Tyr) in the <i>WWOX</i> gene. Variants were inherited from parents with healthy phenotypes. Finally, a patient died at 6 months of age.</p><p><strong>Conclusion: </strong>The discovery of novel variants has enriched the existing database of <i>WWOX</i> gene variants and may expand the range of clinical options for treating <i>WWOX</i>-related disorders.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Delivery room resuscitation and short-term outcomes in very preterm infants: a multicenter cross-sectional study in China. 产房复苏与极早产儿的短期预后:一项在中国进行的多中心横断面研究。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1438780
Hanni Lin, Zhangbin Yu, Jinjie Huang, Ting Yang, Shitao Duan, Yanping Guo, Shujuan Zeng, Ping Jiang, Rui Wang, Jing Zhang, Lu Ding, Jiebo Liu

Objective: To explore the risk factors of delivery room (DR) resuscitation and assess the association of DR resuscitation with neonatal outcomes in very preterm infants (VPIs).

Methods: A multicenter retrospective cross-sectional study included VPIs with gestational age (GA) <32 weeks born between January, 2022 and June, 2023 and admitted to neonatal intensive care units of six tertiary hospitals in Shenzhen within 24 h after birth. They were divided into routine care group, positive-pressure ventilation (PPV) group, and endotracheal intubation (ETT) group based on the highest intensity of resuscitation received at birth. The association of antepartum and intrapartum risk factors and short-term outcomes with the intensity of DR resuscitation was evaluated.

Results: Of 683 infants included in this study, 170 (24.9%) received routine care, 260 (38.1%) received bag and mask ventilation or T-piece ventilation and 253 (37%) received ETT. Among the antepartum and intrapartum factors, exposure to antenatal steroids (ANS) decreased the likelihood of ETT. Increasing GA decreased the likelihood of receiving a higher level of DR resuscitation. Among the neonatal outcomes, increasing intensity of DR resuscitation was associated with a raise in the risk of Bronchopulmonary dysplasia. Higher levels of DR resuscitation were associated with the risk of early-onset sepsis. ETT was significantly associated with an increased risk of death.

Conclusion: Among VPIs, low GA and no ANS use increased the risk of high-intensity DR resuscitation interventions; and those who receiving ETT were associated with an increased risk of adverse clinical outcomes.

目的探讨产房复苏(DR)的风险因素,并评估DR复苏与极早产儿(VPIs)新生儿预后的关系:多中心回顾性横断面研究纳入了胎龄(GA)的极早产儿:在纳入研究的 683 名婴儿中,170 名(24.9%)接受了常规护理,260 名(38.1%)接受了袋罩通气或 T 片通气,253 名(37%)接受了 ETT。在产前和产中因素中,接触产前类固醇(ANS)会降低接受 ETT 的可能性。GA的增加降低了接受更高程度DR复苏的可能性。在新生儿结局中,DR复苏强度的增加与支气管肺发育不良风险的增加有关。更高水平的DR复苏与早发败血症的风险有关。ETT与死亡风险增加密切相关:结论:在自愿住院患者中,低GA和未使用ANS会增加高强度DR复苏干预的风险;接受ETT的患者与不良临床结果的风险增加有关。
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引用次数: 0
Vasopressin induced hyponatremia in infants <3 months of age in the neonatal intensive care unit. 新生儿重症监护室中 3 个月以下婴儿因血管加压素引起的低钠血症。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1465785
Kavita Patel, Sharon Thomson, Meera Vijayan, Marjorie Makoni, Peter N Johnson, Katy Stephens, Stephen B Neely, Jamie L Miller

Objectives: Vasopressin is used for shock and acute pulmonary hypertension in the neonatal intensive care unit (NICU) and is associated with hyponatremia. The purpose of this study was to determine the incidence, severity, contributing risk factors associated with vasopressin-induced hyponatremia in neonates and infants <3 months of age in the NICU. The primary objective was to determine the incidence of hyponatremia (<130 mEq/L) and severe hyponatremia (<125 mEq/L). The secondary objectives were to compare clinical characteristics and the vasopressin regimen between those with and without hyponatremia.

Methods: This retrospective cohort study included neonates and infants <3 months from 1/1/2017-12/31/2022 receiving vasopressin for >6 h. Analyses were performed using SAS v9.4, with a priori less than 0.05. A multiple variable logistic regression was employed to assess odds of hyponatremia.

Results: Of the 105 patients included, 57 (54.3%) developed hyponatremia, and 17 (29.8%) were classified as severe hyponatremia. Overall, the median (interquartile range, IQR) gestational and postnatal age at vasopressin initiation were 35.4 (27-38.7) weeks and 2 (1-12) days. There was no difference in vasopressin dose, but duration of treatment was longer in those with hyponatremia. Higher baseline serum sodium was associated with decreased odds of hyponatremia [adjusted odds ratio (OR): 0.90 (95% CI: 0.83-0.99), p = 0.03], and increased vasopressin duration was associated with increased odds of hyponatremia [aOR: 1.02 (95% CI: 1.01-1.03), p < 0.001].

Conclusions: Hyponatremia occurred in half of patients included. The pre-vasopressin sodium value and the vasopressin duration were independently associated with hyponatremia.

目的:在新生儿重症监护室(NICU)中,血管加压素用于治疗休克和急性肺动脉高压,并与低钠血症有关。本研究旨在确定血管加压素诱发新生儿和婴儿低钠血症的发生率、严重程度和相关风险因素:这项回顾性队列研究包括新生儿和 6 小时以内的婴儿。使用 SAS v9.4 进行分析,先验值小于 0.05。采用多变量逻辑回归评估低钠血症的几率:在纳入的 105 名患者中,57 人(54.3%)出现低钠血症,17 人(29.8%)被归类为严重低钠血症。总体而言,开始使用血管加压素时的妊娠期和产后年龄中位数(四分位距间,IQR)分别为 35.4 周(27-38.7)和 2(1-12)天。血管加压素剂量没有差异,但低钠血症患儿的治疗时间更长。基线血清钠越高,发生低钠血症的几率就越低[调整后的几率比(OR):0.90(95% CI:0.83-0.99),p = 0.03],而血管加压素持续时间越长,发生低钠血症的几率就越高[aOR:1.02(95% CI:1.01-1.03),p 结论:半数患者出现低钠血症。血管加压素前血钠值和血管加压素持续时间与低钠血症有独立关联。
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引用次数: 0
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Frontiers in Pediatrics
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