Jornal de pediatria最新文献_第3页

U-shaped association between hemoglobin to red blood cell distribution width ratio and all-cause mortality among critically ill pediatric patients 危重儿科患者血红蛋白与红细胞分布宽度比与全因死亡率的u型关系

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-17 DOI: 10.1016/j.jped.2025.101491

Weichao He , Jie Liu , Rui Jiang , Xinyu Yang , Xujie Zhang , Ruoyu Cao , Zhenshui Hu , Xiaolan Zhang , Yan Gao

Objective

The lower hemoglobin to red blood cell distribution width ratio (HRR) is associated with an increased risk of mortality in adult patients, but its relationship with clinical progress in the Pediatric Intensive Care Unit (PICU) is unclear. The authors aimed to investigate the association between HRR and all-cause mortality among pediatric patients.

Methods

The authors conducted a retrospective cohort study by analyzing the PIC database from 2010 to 2018.HRR was calculated based on laboratory tests conducted within the first 24 hours of PICU admission. The primary outcome was 28-day in-hospital all-cause mortality. Multivariable logistic regression models, restricted cubic spline, and threshold effects analysis were applied to assess the relationship between HRR and mortality in this cohort.

Results

A total of 8015 patients with an average age of the participants was1.5 (0.4, 4.8) years, and 3547 (44.3%) individuals were female. The 28-day in-hospital all-cause mortality was 4.1% (330/8015). The relationship between HRR and mortality was U-shaped, which had a threshold of around 8.91. The effect size on the left and right sides of the inflection point, was 0.803 (95% CI 0.742-0.869, p < 0.001) and 1.421 (95% CI 1.159-1.743, p < 0.001), respectively. No significant interactions were observed between HRR and all-cause mortality, except in patients with high lactate (p for interaction > 0.05). The results of the sensitivity analysis remained stable.

Conclusions

There is a U-shaped relationship between HRR and 28-day in-hospital all-cause mortality in critically ill pediatric. With a lower mortality risk at an HRR of 8.91.

目的：血红蛋白与红细胞分布宽度比（HRR）降低与成人患者死亡风险增加相关，但其与儿科重症监护病房（PICU）临床进展的关系尚不清楚。作者旨在调查儿科患者HRR与全因死亡率之间的关系。方法：对2010 - 2018年PIC数据库进行回顾性队列研究。HRR是根据PICU入院前24小时内进行的实验室检查计算的。主要终点是28天住院全因死亡率。应用多变量logistic回归模型、受限三次样条和阈值效应分析来评估该队列中HRR与死亡率之间的关系。结果：共有8015例患者，参与者的平均年龄为1.5（0.4,4.8）岁，女性3547例（44.3%）。住院28天全因死亡率为4.1%（330/8015）。HRR与死亡率呈u型关系，阈值约为8.91。拐点左右两侧的效应量分别为0.803 （95% CI 0.742 ~ 0.869, p < 0.001）和1.421 （95% CI 1.159 ~ 1.743, p < 0.001）。除了高乳酸血症患者外，HRR和全因死亡率之间没有观察到显著的相互作用（相互作用p < 0.05）。敏感性分析结果保持稳定。结论：小儿危重症患者HRR与住院28天全因死亡率呈u型关系。死亡风险较低，HRR为8.91。

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引用次数: 0

Children with autism spectrum disorder and alterations in eating behavior: could it be gastroesophageal reflux disease? 儿童自闭症谱系障碍和饮食行为改变：可能是胃食管反流病吗？

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-17 DOI: 10.1016/j.jped.2025.101487

Christine Audet de Almeida , Eduardo Sampaio Siqueira , Marcelo do Rego Maciel Souto Maior , Kátia Galeão Brandt

Objective

Describe the occurrence of warning signs of gastroesophageal reflux disease (GERD) and esophagitis in children with eating behavior (EB) alterations associated with autism spectrum disorder (ASD).

Method

Descriptive study of 115 children aged 3 to 12 years, followed at a tertiary hospital and previously diagnosed with ASD. The BRCA-TEA instrument was applied to identify children with EB alterations, and the 17-ATN-GISSI instrument was applied to identify those with warning signs of GERD. The selected children were invited for a medical consultation to identify those with suspected esophagitis and an indication for upper gastrointestinal (GI) endoscopy with biopsies.

Results

Sixty-nine children (60 %) were classified with alterations in the EB and, among these, 62 (89.8 %) presented warning signs of GERD. Eighteen children had suspected esophagitis and an indication for upper GI endoscopy. Among the 8 children who underwent the exam, 1 child had grade A erosive esophagitis, 1 child had grade B erosive esophagitis, and 1 child had eosinophilic esophagitis.

Conclusion

A high frequency of EB alterations was found in children with ASD. The high frequency of GERD warning signs may be related to EB alterations in this group. Cases of esophagitis highlight the possibility of an organic disease. In these cases, performing upper GI endoscopy with biopsies is essential for diagnosis.

目的：描述与自闭症谱系障碍（ASD）相关的饮食行为（EB）改变儿童胃食管反流病（GERD）和食管炎预警信号的发生情况。方法：对115名3 ~ 12岁儿童进行描述性研究，随访于三级医院，既往诊断为ASD。采用BREB-ASD仪识别EB改变的儿童，采用17-ATN-GISSI仪识别有GERD警告信号的儿童。被选中的儿童被邀请进行医学咨询，以确定那些疑似食管炎和上胃肠道（GI）内窥镜活检的指征。结果：69名儿童（60 %）被分类为EB改变，其中62名（89.8% %）出现GERD的警告信号。18名儿童疑似食管炎，有上消化道内窥镜检查的指征。接受检查的8例患儿中，1例为A级糜烂性食管炎，1例为B级糜烂性食管炎，1例为嗜酸性食管炎。结论：ASD患儿EB改变发生率高。该组胃食管反流警告信号的高频率可能与EB改变有关。食管炎的病例强调器质性疾病的可能性。在这些病例中，进行上消化道内镜活检对诊断至关重要。

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引用次数: 0

Clinical characteristics and gaps in palliative care among tracheostomized children: a retrospective observational study 气管造口术患儿姑息治疗的临床特点和差距：一项回顾性观察研究。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-12 DOI: 10.1016/j.jped.2025.101480

Luziane Lais Sabino Silva Luna, Sheyla Suelle dos Santos Levy, Luciana Santana Lima, Maria do Carmo Menezes Bezerra Duarte

Objective

To describe the clinical characteristics of tracheostomized children in Northeastern Brazil and to identify existing gaps in the indication and implementation of palliative care.

Methods

This retrospective descriptive study reviewed medical records of children under 15 years who underwent tracheostomy between 2008 and 2019 at a quaternary referral center.

Results

Sixty-five tracheostomized patients with indications for palliative care were analyzed. The main reasons for palliative classification were acute life-threatening conditions (50.7 %) and chronic life-threatening conditions (20 %). The most frequent tracheostomy indications were prolonged invasive mechanical ventilation (46.1 %) and severe upper airway obstruction (23 %). The mortality rate was 30.7 %, higher among infants, severely malnourished children, those with Lansky scores below 40 % before tracheostomy, congenital heart disease, bronchopulmonary dysplasia, and multiple comorbidities. Only 10.8 % received palliative care consultations during hospitalization, all in the end-of-life care phase.

Conclusions

The results highlight a critical gap in the provision of palliative care to tracheostomized children. Early involvement of a multidisciplinary palliative care team is crucial to support clinical decision-making, family-centered care, and ensure quality of life. The proposed framework may facilitate timely referral and airway planning in the Intensive therapy, although further validation and qualitative research in various healthcare settings are needed.

目的：描述巴西东北部气管造口手术儿童的临床特征，并确定姑息治疗的指征和实施方面存在的差距。方法：本回顾性描述性研究回顾了2008年至2019年在一家四级转诊中心接受气管切开术的15岁以下儿童的医疗记录。结果：分析了65例气管造口术患者的姑息治疗指征。姑息分类的主要原因是急性危及生命（50.7%）和慢性危及生命（20%）。最常见的气管造口指征是长时间有创机械通气（46.1%）和严重上气道阻塞（23%）。死亡率为30.7%，其中婴儿、严重营养不良儿童、气管切开术前Lansky评分低于40%的儿童、先天性心脏病、支气管肺发育不良和多种合并症的死亡率更高。只有10.8%的人在住院期间接受了姑息治疗咨询，所有这些都是在临终关怀阶段。结论：该结果突出了在气管造口术儿童姑息治疗方面的关键差距。多学科姑息治疗团队的早期参与对于支持临床决策、以家庭为中心的护理和确保生活质量至关重要。尽管需要在各种医疗保健环境中进一步验证和定性研究，但所提出的框架可能有助于在强化治疗中及时转诊和气道规划。

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引用次数: 0

Respiratory mechanic instability in evaluating the effectiveness of adenotonsillectomy for pediatric obstructive sleep apnea 评估儿童阻塞性睡眠呼吸暂停腺扁桃体切除术疗效的呼吸力学不稳定性。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-03 DOI: 10.1016/j.jped.2025.101479

Ji Ho Choi , Yeji Lee , Sungkyoung Shin , Tae Kyoung Ha , Se A. Lee

Objectives

Respiratory mechanic instability (RMI) is characterized by irregular chest and abdominal movements due to upper airway collapse or obstruction, frequently observed during obstructive apnea or hypopnea events. This study aims to explore the potential of RMI as a determinant of adenotonsillectomy's success in treating pediatric obstructive sleep apnea (OSA).

Methods

Medical records of pediatric patients diagnosed with OSA via standard polysomnography who underwent adenotonsillectomy with subsequent follow-up evaluations were retrospectively analyzed. RMI parameters were automatically discerned during polysomnography, and comparisons of sleep scoring data, respiratory events, and RMI metrics (events, index, duration, and % of stage duration) were made pre- and post-surgery.

Results

A total of 42 consecutive pediatric patients with OSA (26 boys, 16 girls) were included in the study. Post-adenotonsillectomy, marked improvements were noted in RMI parameters (events [95.6 ± 43.7 vs 58.9 ± 34.7; p < 0.001], index [14.5 ± 7.0 vs 8.5 ± 4.5; p < 0.001], duration [81.2 ± 56.3 vs 42.1 ± 52.0; p = 0.003], and % of stage duration [20.5 ± 13.9 vs 7.6 ± 6.8; p < 0.001]), along with significant improvements in polysomnographic parameters such as arousal index, AHI, RDI, ODI3, mean oxygen saturation, and snoring duration. Significant correlations were observed between respiratory events (AHI, RDI, ODI3) and RMI metrics such as event counts and index, both before and after the procedure.

Conclusion

This study highlights the effectiveness of adenotonsillectomy in improving sleep quality and respiratory stability in pediatric patients with OSA, underscoring the utility of RMI as a promising additional marker in conjunction with conventional polysomnographic measures.

目的：呼吸力学不稳定（RMI）的特征是由于上呼吸道塌陷或阻塞导致的不规则胸部和腹部运动，经常在阻塞性呼吸暂停或低通气事件中观察到。本研究旨在探讨RMI作为腺扁桃体切除术成功治疗儿童阻塞性睡眠呼吸暂停（OSA）的决定因素的潜力。方法：回顾性分析经标准多导睡眠图诊断为阻塞性睡眠呼吸暂停的儿童患者行腺扁桃体切除术并随访评价的病历。在多导睡眠描记术中自动识别RMI参数，并对手术前后的睡眠评分数据、呼吸事件和RMI指标（事件、指数、持续时间和阶段持续时间的百分比）进行比较。结果：共有42例连续儿科OSA患者（26例男孩，16例女孩）被纳入研究。腺扁桃体切除术后，RMI参数显著改善（事件[95.6 ± 43.7 vs 58.9 ± 34.7;p ]）结论：本研究强调了腺扁桃体切除术在改善儿童OSA患者睡眠质量和呼吸稳定性方面的有效性，强调了RMI作为与常规多道睡眠图测量相结合的有希望的额外标记物的作用。

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引用次数: 0

Association of blood transfusion-related DEHP exposure with gut microbiota alterations in preterm infants 输血相关DEHP暴露与早产儿肠道菌群改变的关系

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-28 DOI: 10.1016/j.jped.2025.101476

Yung-Ning Yang , Yu-Chen S.H. Yang , San-Nan Yang , Ying-Yu Chen , Hung-Yun Lin , Jau-Ling Suen

Objective

Avoiding early-life exposure to environmental endocrine disruptors (EDCs) is critical for neonatal growth and long-term health. However, exposure to Di-(2-ethylhexyl) phthalate (DEHP), a typical EDC and plasticizer, is unavoidable in neonatal intensive care units due to contact with polyvinyl chloride medical devices.

Methods

This study examined the impact of DEHP exposure through blood transfusion on gut microbiota development in preterm infants. To address this aim, the authors conducted a prospective cohort study, enrolling preterm infants between May 1, 2016, and March 30, 2021, who had not received blood transfusions or antibiotic treatment for at least seven consecutive days prior to enrollment. Fecal samples collected before and after transfusion underwent 16S ribosomal RNA gene-based next-generation sequencing analysis, while DEHP levels were measured in post-transfusion blood products. The average DEHP level in these products was 0.072 ± 0.03 mg/mL.

Results

Initial analysis of 23 preterm infants (including five recruited twice) indicated that blood transfusion did not significantly alter bacterial composition and diversity. However, when examining recruitment events by postmenstrual age (PMA) or days of life (DOL), a significant increase in Enterococcus abundance was observed in both the lower PMA and younger DOL groups.

Conclusions

These findings suggest a possible association between early-life DEHP exposure via blood transfusion and altered gut microbiota. Further studies are needed to clarify causality and long-term health implications.

目的：避免早期接触环境内分泌干扰物（EDCs）对新生儿生长和长期健康至关重要。然而，在新生儿重症监护病房，由于接触聚氯乙烯医疗器械，暴露于典型的EDC和增塑剂邻苯二甲酸二（2-乙基己基）酯（DEHP）是不可避免的。方法：本研究考察了输血暴露DEHP对早产儿肠道微生物群发育的影响。为了实现这一目标，作者进行了一项前瞻性队列研究，招募了2016年5月1日至2021年3月30日期间未接受输血或抗生素治疗的早产儿，这些早产儿在入组前至少连续7天未接受输血或抗生素治疗。在输血前后收集的粪便样本进行基于16S核糖体RNA基因的新一代测序分析，同时在输血后血液制品中测量DEHP水平。这些产品的DEHP平均含量为0.072 ± 0.03 mg/mL。结果：对23名早产儿（包括5名两次招募的早产儿）的初步分析表明，输血没有显著改变细菌的组成和多样性。然而，当通过月经后年龄（PMA）或生命天数（DOL）检查招募事件时，在较低PMA组和较年轻DOL组中都观察到肠球菌丰度的显着增加。结论：这些发现表明，生命早期通过输血接触DEHP与肠道菌群改变之间可能存在关联。需要进一步的研究来澄清因果关系和长期健康影响。

{"title":"Association of blood transfusion-related DEHP exposure with gut microbiota alterations in preterm infants","authors":"Yung-Ning Yang , Yu-Chen S.H. Yang , San-Nan Yang , Ying-Yu Chen , Hung-Yun Lin , Jau-Ling Suen","doi":"10.1016/j.jped.2025.101476","DOIUrl":"10.1016/j.jped.2025.101476","url":null,"abstract":"<div><h3>Objective</h3><div>Avoiding early-life exposure to environmental endocrine disruptors (EDCs) is critical for neonatal growth and long-term health. However, exposure to Di-(2-ethylhexyl) phthalate (DEHP), a typical EDC and plasticizer, is unavoidable in neonatal intensive care units due to contact with polyvinyl chloride medical devices.</div></div><div><h3>Methods</h3><div>This study examined the impact of DEHP exposure through blood transfusion on gut microbiota development in preterm infants. To address this aim, the authors conducted a prospective cohort study, enrolling preterm infants between May 1, 2016, and March 30, 2021, who had not received blood transfusions or antibiotic treatment for at least seven consecutive days prior to enrollment. Fecal samples collected before and after transfusion underwent 16S ribosomal RNA gene-based next-generation sequencing analysis, while DEHP levels were measured in post-transfusion blood products. The average DEHP level in these products was 0.072 ± 0.03 mg/mL.</div></div><div><h3>Results</h3><div>Initial analysis of 23 preterm infants (including five recruited twice) indicated that blood transfusion did not significantly alter bacterial composition and diversity. However, when examining recruitment events by postmenstrual age (PMA) or days of life (DOL), a significant increase in <em>Enterococcus</em> abundance was observed in both the lower PMA and younger DOL groups.</div></div><div><h3>Conclusions</h3><div>These findings suggest a possible association between early-life DEHP exposure via blood transfusion and altered gut microbiota. Further studies are needed to clarify causality and long-term health implications.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101476"},"PeriodicalIF":2.5,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The role of neuropsychological assessment in the investigation of neurodevelopmental disorders 神经心理学评估在神经发育障碍研究中的作用。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-26 DOI: 10.1016/j.jped.2025.101470

Danielle Irigoyen da Costa , Rosana Vieira de Souza , Thaís Cecília Fiamoncini

Objective

The present study aims to present and discuss the role of neuropsychological assessment (NA) in the investigation of neurodevelopmental disorders (NDDs), with an emphasis on early diagnosis, on the steps that make up the evaluation process, and on the resources that complement clinical evaluation. Furthermore, the discussion is expanded to specific conditions, such as Attention Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Specific Learning Disorders (SLD), considering that they represent frequent assessment demands.

Data sources

A critical review of the national and international literature on neuropsychological assessment in NDDs was carried out, highlighting standardized instruments for the Brazilian context, complementary clinical tasks, and main cognitive and behavioral domains. References to essential books and manuals were included, with analysis enriched by the authors' clinical and teaching experience.

Data synthesis

NA constitutes a central tool for the early identification of alterations in neurodevelopment, with contributions to diagnosis and to the definition of intervention strategies. The process involves systematic steps, such as detailed anamnesis, application of standardized tests, and behavior analysis, covering different domains. The feedback, the final stage of the process, is essential for the understanding of the results and for adhering to the suggested procedures, and it should guide parents on practical implications, therapeutic and educational recommendations, and necessary referrals.

Conclusions

NA represents an essential resource in pediatric practice, both for diagnostic support and for directing interventions and monitoring the progress of children with NDDs. Its early use can modify the prognosis and promote better functional, academic, and socioemotional outcomes.

目的：本研究旨在介绍和讨论神经心理学评估（NA）在神经发育障碍（ndd）调查中的作用，重点是早期诊断，构成评估过程的步骤，以及补充临床评估的资源。此外，讨论扩展到特定条件，如注意缺陷/多动障碍（ADHD），自闭症谱系障碍（ASD）和特殊学习障碍（SLD），考虑到它们代表了频繁的评估需求。数据来源：对ndd神经心理评估的国内和国际文献进行了批判性回顾，强调了巴西背景下的标准化工具，补充临床任务，以及主要的认知和行为领域。参考必要的书籍和手册包括，分析丰富了作者的临床和教学经验。数据综合：NA构成了早期识别神经发育改变的核心工具，有助于诊断和干预策略的定义。这个过程包括系统的步骤，如详细的记忆、标准化测试的应用和行为分析，涵盖了不同的领域。反馈是这个过程的最后一个阶段，对于理解结果和遵守建议的程序是至关重要的，它应该指导家长对实际影响、治疗和教育建议以及必要的转诊。结论：NA代表了儿科实践中的重要资源，无论是诊断支持还是指导干预和监测ndd患儿的进展。早期使用它可以改善预后，促进更好的功能、学业和社会情感结果。

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引用次数: 0

Serological biomarker models composed of luteinizing hormone, kisspeptin, vitamin D and estradiol, and their clinical test value in girls 促黄体生成素、kisspeptin、维生素D和雌二醇组成的血清生物标志物模型及其在女孩中的临床检测价值。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-22 DOI: 10.1016/j.jped.2025.101477

Mingyu Shao , Zhiyi Jia , Tongtong Liu , Xiaopeng Zhang

Objective

Central precocious puberty (CPP) may lead to premature pubertal onset. While the GnRH stimulation test remains the gold standard, its invasive nature and prolonged procedure limit clinical utility, particularly in pediatric populations. Emerging biomarkers, including luteinizing hormone, estradiol, kisspeptin, and vitamin D, have shown promise in distinguishing CPP from normal puberty. This study systematically evaluated the diagnostic utility of these biomarkers both individually and in novel combinatorial models, with the aim of establishing a non-invasive and more accessible diagnostic alternative for CPP.

Methods

This retrospective study included 129 girls with CPP and 116 age-matched controls. Clinical characteristics, including height, weight, body mass index, and bone age, were recorded. Serum levels of luteinizing hormone, estradiol, kisspeptin, vitamin D, progesterone, and prolactin were measured. The diagnostic performance of individual biomarkers and three combined biomarker models was assessed using receiver operating characteristic curve analysis.

Results

Model 1 included luteinizing hormone and kisspeptin, Model 2 incorporated vitamin D, and Model 3 added estradiol. CPP patients exhibited significantly higher levels of luteinizing hormone (2.51 vs. 0.23 mIU/mL), kisspeptin (1.59 vs. 0.96 μg/L), and estradiol (25.86 vs. 13.41 pg/mL) and lower vitamin D levels (20.13 vs. 25.90 ng/mL) compared to controls (all p < 0.001). Model 3 demonstrated the highest diagnostic accuracy with an AUC of 0.939 (95 % CI: 0.910–0.968), sensitivity of 89.06 %, and specificity of 87.93 %, outperforming individual biomarkers and other models.

Conclusion

This study highlights the potential of combining luteinizing hormone, kisspeptin, vitamin D, and estradiol into a single diagnostic model for CPP.

目的：中枢性性早熟（CPP）可能导致青春期早发。虽然GnRH刺激试验仍然是金标准，但其侵入性和冗长的程序限制了临床应用，特别是在儿科人群中。新兴的生物标志物，包括黄体生成素、雌二醇、kisspeptin和维生素D，已经显示出将CPP与正常青春期区分开来的希望。本研究系统地评估了这些生物标志物的诊断效用，包括单独的和新的组合模型，目的是建立一种非侵入性和更容易获得的CPP诊断替代方案。方法：回顾性研究纳入129例CPP女孩和116例年龄匹配的对照组。记录临床特征，包括身高、体重、身体质量指数和骨龄。测定血清黄体生成素、雌二醇、kisspeptin、维生素D、黄体酮和催乳素水平。使用受试者工作特征曲线分析评估单个生物标志物和三种组合生物标志物模型的诊断性能。结果：模型1含促黄体生成素和kisspeptin，模型2加入维生素D，模型3加入雌二醇。CPP患者黄体生成素水平明显高于对照组（2.51 ）。0.23 mIU/mL), kisspeptin(1.59 vs.；0.96 μg/L)，雌二醇(25.86 ；13.41 pg/mL)和更低的维生素D水平(20.13 vs。25.90 ng/mL)与对照组相比（均p ）结论：本研究强调了将促黄体生成素、kisspeptin、维生素D和雌二醇联合用于CPP的单一诊断模型的潜力。

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引用次数: 0

Development of a machine learning-based predictive model for long-term adverse outcomes in neonatal bacterial meningitis 基于机器学习的新生儿细菌性脑膜炎长期不良后果预测模型的开发。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-21 DOI: 10.1016/j.jped.2025.101472

Ying Chen , Shengpei Wang , Jing Wu , Chi Wang , Ying Li , Peicen Zou , Ruiqi Xiao , Na Zhang , Huiguang He , Yajuan Wang

Objective

To explore the application of machine learning methods for screening risk factors for long-term adverse prognosis in neonatal bacterial meningitis, determine the final prediction model, and evaluate its predictive value.

Methods

This study included 139 full-term neonates diagnosed with neonatal bacterial meningitis in the capital institute of pediatrics between January 2019 and December 2023. Based on follow-up outcomes, they were divided into a poor prognosis group (n = 45) and a good prognosis group (n = 94). Thirty-three clinical variables were collected. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator, Boruta, and Recursive Feature Elimination. Seven machine learning models were constructed. Model performance was evaluated using metrics including the area under the receiver operating characteristic curve, accuracy, and sensitivity. The Shapley Additive explanation method was used to interpret the models.

Results

Among the seven models, The Random Forest model demonstrates the best overall predictive performance, although Logistic Regression achieved the highest discriminative ability (AUC: 0.903), Random Forest was more suitable for clinical application due to its superior accuracy (0.881), better calibration (Brier score: 0.123), and balanced sensitivity (0.887) and specificity (0.878). Shapley Additive explanation interpretability analysis further revealed that the top three important features were cerebrospinal fluid white blood cell count, cerebrospinal fluid protein levels, and seizures.

Conclusion

Machine learning models, particularly the superior-performing Random Forest, are proven to reliably predict long-term adverse outcomes in NBM patients, aiding in the identification of high-risk individuals. Further validation in broader cohorts is warranted to enhance generalizability and clinical applicability.

目的：探讨机器学习方法在新生儿细菌性脑膜炎长期不良预后危险因素筛查中的应用，确定最终预测模型，并评价其预测价值。方法：本研究纳入2019年1月至2023年12月在首都儿科研究所诊断为新生儿细菌性脑膜炎的139例足月新生儿。根据随访结果分为预后不良组（n = 45）和预后良好组（n = 94）。收集33个临床变量。使用最小绝对收缩和选择算子、Boruta和递归特征消除进行特征选择。构建了7个机器学习模型。使用指标评估模型性能，包括接收器工作特性曲线下的面积、精度和灵敏度。采用Shapley加性解释法对模型进行解释。结果：在7个模型中，Random Forest模型的整体预测性能最好，尽管Logistic回归的判别能力最高（AUC: 0.903），但Random Forest模型因其更高的准确率（0.881），更好的校准（Brier评分：0.123），平衡了敏感性（0.887）和特异性（0.878）而更适合临床应用。Shapley加性解释可解释性分析进一步揭示了最重要的三个特征是脑脊液白细胞计数、脑脊液蛋白水平和癫痫发作。结论：机器学习模型，特别是性能优异的Random Forest，被证明可以可靠地预测NBM患者的长期不良后果，有助于识别高风险个体。在更广泛的队列中进一步验证是有必要的，以提高普遍性和临床适用性。

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引用次数: 0

The role of continuous renal replacement therapy in critically ill children with cancer and multiple organ dysfunction syndrome 持续肾脏替代治疗在患有癌症和多器官功能障碍综合征的危重儿童中的作用。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-20 DOI: 10.1016/j.jped.2025.101473

Fernanda P.L.F. Veiga , Orlei R. Araujo , Alessandra S. Araujo , Marcela S. Bicalho , Maria C. Andrade , Dafne C.B. Silva

Objectives

To describe the demographic and clinical characteristics of pediatric cancer patients receiving continuous renal replacement therapy (CRRT) and to analyze its effect on biochemical markers.

Methods

The authors conducted a cohort study of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in a pediatric oncology intensive care unit. Biochemical measurements were compared at CRRT initiation (D0), after 72 h (D3), and during the final 72 h of therapy.

Results

Fifty-nine cases were analyzed. Hospital mortality was 67.7 %, and the median duration of CRRT was 9 days. Fluid overload was present in 51 % of patients; the mean KDIGO score was 2 (SD: 1). Mechanical ventilation was required in 79.7 %. Among survivors, significant improvements were observed in pH (mean 7.34 on D0 vs. 7.41 on D3; p = 0.012; effect size: 0.72) and bicarbonate (mean 22.17 on D0 vs. 27.1 on D3; p = 0.003; effect size: 0.77). In non-survivors, lactate levels increased over time (mean 2.3 on D0 vs. 5.37 on the last day; p = 0.03; effect size: 0.49). Generalized estimating equation models identified bicarbonate (OR: 0.05), pH (OR: 0.92), PCO₂ (OR: 176), and lactate (OR: 9.8) as significant predictors of in-hospital death. Logistic regression showed that mechanical ventilation (OR: 8.48) and fluid overload in the final 72 h (OR: 1.15) were associated with mortality.

Conclusions

While CRRT’s impact on mortality in MODS remains uncertain, it improved biochemical markers. The findings suggest that metabolic and lactic acidosis, fluid overload, and mechanical ventilation may be modifiable targets to reduce mortality.

目的：描述接受持续肾替代治疗（CRRT）的儿童肿瘤患者的人口学和临床特征，并分析其对生化指标的影响。方法：作者对在儿科肿瘤重症监护病房接受CRRT治疗的多器官功能障碍综合征（MODS）患者进行了一项队列研究。在CRRT开始时（D0）、72小时后（D3）和治疗后72小时进行生化测量比较。结果：共分析59例。住院死亡率为67.7 %，CRRT的中位持续时间为9天。51 %的患者出现体液超载；平均KDIGO评分为2分（SD: 1）。79.7% %需要机械通气。在幸存者中，pH值（D0组平均为7.34，D3组为7.41;p = 0.012；效应值：0.72）和碳酸氢盐（D0组平均为22.17，D3组为27.1;p = 0.003；效应值：0.77）均有显著改善。在非幸存者中，乳酸水平随着时间的推移而增加（D0时平均2.3 vs.最后一天平均5.37;p = 0.03；效应量：0.49）。广义估计方程模型确定碳酸氢盐（OR: 0.05）、pH （OR: 0.92）、PCO 2 （OR: 176）和乳酸盐（OR: 9.8）是院内死亡的重要预测因子。Logistic回归分析显示，机械通气（OR: 8.48）和最后72 h液体负荷（OR: 1.15）与死亡率相关。结论：虽然CRRT对MODS患者死亡率的影响尚不确定，但它改善了生化指标。研究结果表明，代谢性和乳酸性酸中毒、液体超载和机械通气可能是降低死亡率的可修改目标。

{"title":"The role of continuous renal replacement therapy in critically ill children with cancer and multiple organ dysfunction syndrome","authors":"Fernanda P.L.F. Veiga , Orlei R. Araujo , Alessandra S. Araujo , Marcela S. Bicalho , Maria C. Andrade , Dafne C.B. Silva","doi":"10.1016/j.jped.2025.101473","DOIUrl":"10.1016/j.jped.2025.101473","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the demographic and clinical characteristics of pediatric cancer patients receiving continuous renal replacement therapy (CRRT) and to analyze its effect on biochemical markers.</div></div><div><h3>Methods</h3><div>The authors conducted a cohort study of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in a pediatric oncology intensive care unit. Biochemical measurements were compared at CRRT initiation (D0), after 72 h (D3), and during the final 72 h of therapy.</div></div><div><h3>Results</h3><div>Fifty-nine cases were analyzed. Hospital mortality was 67.7 %, and the median duration of CRRT was 9 days. Fluid overload was present in 51 % of patients; the mean KDIGO score was 2 (SD: 1). Mechanical ventilation was required in 79.7 %. Among survivors, significant improvements were observed in pH (mean 7.34 on D0 vs. 7.41 on D3; <em>p</em> = 0.012; effect size: 0.72) and bicarbonate (mean 22.17 on D0 vs. 27.1 on D3; <em>p</em> = 0.003; effect size: 0.77). In non-survivors, lactate levels increased over time (mean 2.3 on D0 vs. 5.37 on the last day; <em>p</em> = 0.03; effect size: 0.49). Generalized estimating equation models identified bicarbonate (OR: 0.05), pH (OR: 0.92), PCO₂ (OR: 176), and lactate (OR: 9.8) as significant predictors of in-hospital death. Logistic regression showed that mechanical ventilation (OR: 8.48) and fluid overload in the final 72 h (OR: 1.15) were associated with mortality.</div></div><div><h3>Conclusions</h3><div>While CRRT’s impact on mortality in MODS remains uncertain, it improved biochemical markers. The findings suggest that metabolic and lactic acidosis, fluid overload, and mechanical ventilation may be modifiable targets to reduce mortality.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101473"},"PeriodicalIF":2.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epidemiological and clinical characteristics associated with enterovirus D68 respiratory diseases in Asian children: a systematic review and meta-analysis 亚洲儿童肠道病毒D68呼吸道疾病相关的流行病学和临床特征：一项系统综述和荟萃分析

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-14 DOI: 10.1016/j.jped.2025.101475

Xiaojing Lu , Bingbing Li , Shufang Li , Lihong Wang , Guangen Guo , Yanli Zhang , Jiajia Duan , Changlian Zhu

Objective

This study aimed to determine the epidemiology and clinical characteristics of EV-D68-associated respiratory diseases among Asian children.

Sources

The PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), VIP, WanFang, and SinoMed electronic databases were searched from inception to February 28, 2025, to identify relevant articles. Studies reporting the detection rate of enterovirus D68 (EV-D68) in pediatric patients with respiratory tract infections were included. The methodological quality regarding the risk of bias was assessed according to the approach proposed by the Joanna Briggs Institute.

Summary of the findings

Twenty studies involving 47,451 participants were included; additionally, 450 participants were positive for EV-D68 infection. The detection rate of EV-D68 ranged from 0.23 % to 10.56 %, with a pooled prevalence of 1.29 % (95 % CI 0.88–1.78 %), but significant heterogeneity (I² = 94.20 %, p < 0.001) indicated that this estimate was context-dependent. Subgroup analyses revealed that detection rates varied substantially by country, study period, and income level. Pneumonia is the most common respiratory disease presentation. EV-D68 is most prevalent during the summer and autumn.

Conclusion

This is the first review to focus specifically on Asian children, which suggests that EV-D68 detection rates vary significantly across Asian populations and are especially influenced by geographic location and surveillance timing. EV-D68 infection in children is most frequently associated with pneumonia. These findings support targeted regional surveillance networks during the summer-autumn seasons to improve clinical diagnostics and public health responses.

Trial Registration

PROSPERO Identifier: CRD42023449889.

目的：本研究旨在了解亚洲儿童ev - d68相关呼吸道疾病的流行病学和临床特征。资料来源：检索PubMed、Embase、Web of Science、Scopus、CNKI、VIP、万方、SinoMed等电子数据库，检索时间为创刊至2025年2月28日。研究报告了肠道病毒D68 （EV-D68）在儿科呼吸道感染患者中的检出率。根据乔安娜布里格斯研究所提出的方法评估偏倚风险的方法学质量。研究结果总结：纳入了20项研究，涉及47,451名参与者；此外，450名参与者的EV-D68感染呈阳性。的检出率EV-D68范围从0.23 % 10.56 %,汇集患病率为1.29 %(95 %可信区间0.88 - -1.78 %),但是显著的异质性(我²  % = 94.20,p 结论:这是第一个评论特别关注亚洲的孩子,这表明EV-D68亚洲人群检出率显著不同,尤其受地理位置的影响和监测时机。儿童感染EV-D68最常与肺炎相关。这些发现支持在夏秋季节建立有针对性的区域监测网络，以改进临床诊断和公共卫生反应。试验注册：PROSPERO标识符：CRD42023449889。

{"title":"Epidemiological and clinical characteristics associated with enterovirus D68 respiratory diseases in Asian children: a systematic review and meta-analysis","authors":"Xiaojing Lu , Bingbing Li , Shufang Li , Lihong Wang , Guangen Guo , Yanli Zhang , Jiajia Duan , Changlian Zhu","doi":"10.1016/j.jped.2025.101475","DOIUrl":"10.1016/j.jped.2025.101475","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to determine the epidemiology and clinical characteristics of EV-D68-associated respiratory diseases among Asian children.</div></div><div><h3>Sources</h3><div>The PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), VIP, WanFang, and SinoMed electronic databases were searched from inception to February 28, 2025, to identify relevant articles. Studies reporting the detection rate of enterovirus D68 (EV-D68) in pediatric patients with respiratory tract infections were included. The methodological quality regarding the risk of bias was assessed according to the approach proposed by the Joanna Briggs Institute.</div></div><div><h3>Summary of the findings</h3><div>Twenty studies involving 47,451 participants were included; additionally, 450 participants were positive for EV-D68 infection. The detection rate of EV-D68 ranged from 0.23 % to 10.56 %, with a pooled prevalence of 1.29 % (95 % CI 0.88–1.78 %), but significant heterogeneity (<em>I</em>² = 94.20 %, <em>p</em> < 0.001) indicated that this estimate was context-dependent. Subgroup analyses revealed that detection rates varied substantially by country, study period, and income level. Pneumonia is the most common respiratory disease presentation. EV-D68 is most prevalent during the summer and autumn.</div></div><div><h3>Conclusion</h3><div>This is the first review to focus specifically on Asian children, which suggests that EV-D68 detection rates vary significantly across Asian populations and are especially influenced by geographic location and surveillance timing. EV-D68 infection in children is most frequently associated with pneumonia. These findings support targeted regional surveillance networks during the summer-autumn seasons to improve clinical diagnostics and public health responses.</div></div><div><h3>Trial Registration</h3><div>PROSPERO Identifier: CRD42023449889.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101475"},"PeriodicalIF":2.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0