Pediatric Research最新文献

Impact: Comment on novel dose-dependent relationship described between visceral adiposity index and asthma in US children and adolescents.

The COVID-19 pandemic accelerated a global shift from face-to-face to digital healthcare, increasing demand for valid and reliable tools that can be administered remotely. The Alberta Infant Motor Scale (AIMS) is a widely used observational measure of infant gross motor development, yet evidence supporting its psychometric performance via telehealth remains limited. This study evaluated the validity of remote AIMS administration across three digital modalities compared with traditional in-person assessment. Findings demonstrated excellent agreement between remote and face-to-face scores, confirming that virtual administration provides clinically reliable information about infant motor development. Validating the AIMS for telehealth has substantial implications for equity, research, and clinical practice. Remote delivery reduces travel, cost, and logistical barriers, improving access to early developmental assessment for families in rural, remote, or low-socioeconomic contexts. Reliable remote assessment also enables broader research participation and supports hybrid clinical models that maintain continuity of care when in-person visits are not feasible. These results strengthen confidence in digital modes of assessment and highlight remote AIMS administration as a viable, scalable approach to early developmental surveillance. The findings offer particular benefit for infants who face the greatest barriers to timely evaluation and intervention. IMPACT: Strengthens confidence in telehealth as a legitimate and scalable mode of early motor surveillance, especially for infants at risk of delay. Expands opportunities for equitable access by enabling high-quality assessment for families in rural, remote, or low-resource settings with barriers to in-person services. Supports inclusive and decentralised research models, enabling broader recruitment, reduced participant burden, and improved monitoring in clinical trials and developmental follow-up.

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disorder in preterm infants. The interplay between mitochondrial metabolism and immune inflammation in its development is not fully understood.

Methods: Single-cell data were analyzed using dimensionality reduction, clustering, and the high-dimensional weighted gene co-expression network analysis (hdWGCNA) algorithm to identify key gene modules in monocytes. GSE46619 was integrated with the MitoCarta3.0 to identify mitochondria-associated differentially expressed genes (MitoDEGs). Acyl-CoA synthetase long-chain family member 1 (ACSL1) was selected as a candidate. Immune infiltration was evaluated via the CIBERSORT algorithm, and a competing endogenous RNA (ceRNA) regulatory network was constructed using Cytoscape. The expression and function of ACSL1 were validated both in vivo and in vitro, using immunohistochemistry (IHC), qRT-PCR, western blot, and siRNA knockdown.

Results: A key monocyte subset was identified in NEC. Integrated analysis revealed three MitoDEGs (ACSL1, SOD2, SLC25A37) were linked to NEC, with ACSL1 showing the most significant upregulation. ACSL1 expression correlated strongly with immune cell infiltration and was confirmed to be elevated in vivo and in vitro models. Knocking down ACSL1 suppressed lipopolysaccharide (LPS)-induced inflammatory factor expression and ROS production.

Conclusion: ACSL1 plays a critical role in the pathogenesis of NEC, suggesting its potential as a novel biomarker.

Impact: Our study reveals massive monocyte infiltration and identifies the mitochondria-related gene ACSL1 as highly expressed and functionally significant in NEC. This is the first integrated analysis (single-cell, hdWGCNA, MitoCarta3.0) pinpointing ACSL1 as a novel immunometabolic hub specific to NEC pathophysiology. ACSL1 provides a crucial mechanistic link between mitochondrial function and NEC development. It significantly correlates with key immune cells (neutrophils/mast cells/macrophages/T cells), highlighting its role in NEC immune dysregulation. These findings reveal a critical role of ACSL1 in NEC pathogenesis, highlighting its potential as a novel biomarker.

Background: The NICHD Neonatal Research Network MILK Trial randomized infants born preterm to receive donor milk or preterm formula. We hypothesized that there would be no growth differences at follow-up by study diet.

Methods: We conducted a secondary analysis of the double-blind trial of infants <29 weeks' gestation or <1000 g at birth at 15 US centers (September 2012-March 2019). Infants were randomized to receive donor milk or preterm formula. The primary outcome was body mass index (BMI) Z-score at 22-26 months corrected age.

Results: Among 483 trial participants, 376 were seen at follow-up (181 donor milk, 195 formula). At 22-26 month follow-up, anthropometrics were similar for the two groups, including BMI Z-score (donor milk 0.21 ± 1.13, formula 0.23 ± 1.28, p = 0.67). There was a greater increase in weight Z-score between discharge and follow-up for children randomized to donor milk (donor milk 1.04 ± 1.28, formula 0.73 ± 1.30, p = 0.004).

Conclusions: While BMI Z-scores were similar at 22-26 months corrected age, patterns of growth between discharge and follow-up differed by study diet. Children fed donor milk in early infancy showed a greater increase in weight Z-score between discharge and follow-up than children fed preterm formula in early infancy.

Impact: At 2 years, the anthropometrics were similar for children randomized to donor milk or preterm formula in early infancy. Patterns of growth between discharge and follow-up differed by early infancy diet. There was a greater weight Z-score increase between discharge and follow-up for children randomized to donor milk than formula. Donor milk appears to be non-inferior to preterm formula with respect to growth at 2 years for children born extremely preterm. Policies and practices that facilitate parental milk provision and donor milk availability are needed for infants born extremely preterm.

Background: Fortification of human milk for very preterm infants (VPIs) with alternatives to conventional bovine milk-based fortifiers remains minimally studied. This trial tested whether fortification with protein-rich bovine colostrum (BC) improves feeding intolerance and clinical variables in VPIs receiving enteral nutrition with a relatively slow advancement.

Methods: In this unblinded, two-centre, randomised, controlled trial (FortiColos CN), VPIs (gestational age, 26 + 0 to 31 + 6 weeks) were fed human milk fortified with BC (n = 74) or a conventional fortifier (CF, FM85, Nestlé, n = 72) for at least two weeks, starting when enteral feeding volume reached 80-100 mL/kg body weight/d. Incidence of feeding intolerance, nutrition intake, body growth, morbidities and clinical biochemical parameters were compared between the two groups.

Results: No statistically significant difference was found in the incidence of feeding intolerance or in most of the nutritional or body growth parameters (p > 0.05). All recorded morbidity incidences and haematological and blood biochemical parameters were also similar between groups. Amino acids (Phe, Pro, Ser, Tyr, Val) showed higher levels in the infants receiving BC.

Conclusions: BC appeared safe when used as a fortifier to human milk for VPIs with slow feeding advancement, but did not improve feeding tolerance or clinical variables.

Impact: Fortifying human milk with bovine colostrum (BC) in very preterm infants (VPIs) is safe but did not improve feeding tolerance, growth or clinical outcomes, compared with a conventional fortifier (CF), when used during slow enteral feeding advancement. This study adds to the limited clinical evidence on the use of BC as a human milk fortifier in VPIs receiving enteral feeding with different feeding protocols. The findings support the safety of BC as a human milk fortifier in VPIs but suggest limited short-term clinical benefits over currently used fortifiers.

Background: Each year, over half a million children worldwide are born extremely prematurely (EPI), often requiring potentially harmful ventilatory support. An artificial placenta with gas exchange provided by an oxygenator offers an alternative. However, current oxygenators are not designed for long-term applications in patients experiencing growth. Thus, a new type of "growing" oxygenator is needed.

Methods: We developed the A-Maze-Ox, a novel maze-inspired membrane oxygenator featuring two concentric compartments that can be opened sequentially to address patient growth. Each compartment has a priming volume of 5 mL and a gas exchange area of 0.065 m². The prototype was tested for feasibility, gas transfer performance and pressure loss according to ISO 7199.

Results: Adding the second compartment increased O₂ and CO₂ transfer performance by 57.06% and 35.59%, respectively. While CO₂ transfer was mostly sufficient, O₂ transfer remained below the target. The targeted maximum pressure drop of 20 mmHg was exceeded at 90 mL/min.

Conclusions: The A-Maze-Ox demonstrates the ability to adapt to increasing demands with good results in CO₂ elimination but requires improvement in terms of O₂ transfer and pressure drop. However, it shows the potential for a growing oxygenator in future artificial placenta applications.

Impact: Current oxygenators cannot adapt to the dynamic patient growth of extremely premature infants. A-Maze-Ox-a novel membrane oxygenator with two compartments can adapt to growth. Each compartment has a volume of 5 mL and a gas exchange area of 0.065 m². Oxygen transfer increased by 57.06% and carbon dioxide transfer by 35.59% when adding the second compartment. A-Maze-Ox could improve health of extremely premature infants in the future.

Impact: Call for action to implement special interest groups regarding planetary health within pediatric research societies Pointing out the role and responsibility of pediatricians and pediatric researchers in times of climate crisis Raising awareness about research gaps, e.g., regarding mitigation strategies Focusing on the carbon footprint of conferences, hospitals and, laboratories Recommendations for sustainable medical and research practice.

Background: Bronchopulmonary dysplasia (BPD) and significant hemodynamic patent ductus arteriosus (hsPDA) are both common and important clinical issues in extremely preterm infants. The potential impact on prognosis when these conditions coexist is a major focus of clinical concern. This study examined the relationship between hsPDA and adverse outcomes in BPD infants.

Methods: A retrospective analysis of 781 preterm infants (<32 weeks) from three hospitals (2018-2023). Based on echocardiographic assessment, infants were categorized as the non-PDA group, the non-hsPDA group, or the hsPDA group. Further subgroups were formed according to treatment and ductus arteriosus size (<1.5 mm, 1.5-3 mm, ≥3 mm). The effects of hsPDA on short-term outcomes in infants with BPD were assessed using logistic regression and linear regression.

Results: The study included 781 infants (548 non-BPD, 233 BPD). The hsPDA subgroup had lower gestational age, higher birth asphyxia rates, and required more invasive respiratory support. In BPD infants, hsPDA was linked to longer respiratory support, higher pneumonia and feeding intolerance risks, prolonged oxygen therapy, and PH. Infants with hsPDA had longer hospital stays and oxygen therapy. Intervention therapy in infants with hsPDA was associated with prolonged oxygen therapy duration, reduced feeding intolerance, and increased risk of pulmonary hypertension（PH）. Meanwhile, ductus arteriosus diameter >3 mm was linked to elevated risks of feeding intolerance, pulmonary hypertension, and extrauterine growth restriction. After adjusting for gestational age and birth weight, results from multivariate logistic regression and multiple linear regression analyses indicated that hsPDA was independently associated with increased risk of neonatal PH (aOR = 7.502, 95% CI: 4.046-13.911, P < 0.001) and significantly prolonged invasive respiratory support duration (β = 6.530 days, 95% CI: 1.691-11.368, P = 0.008).

Conclusion: In BPD infants, hsPDA is associated with the occurrence of PH and longer duration of invasive respiratory support.

Impact: This study highlights the significant correlation between hemodynamically significant patent ductus arteriosus (hsPDA) and adverse outcomes in infants diagnosed with bronchopulmonary dysplasia (BPD), providing valuable clinical evidence for better management strategies. This study adds to the literature by showing that in very preterm infants with BPD, the presence of hsPDA was independently correlated with both an increased risk of pulmonary hypertension and a longer duration of invasive respiratory support.