Pediatric Research最新文献

Background: Exclusive breastfeeding (EBF) rates at 6 months postpartum remain low globally and in Hong Kong. This prospective mixed-method study examined the barriers to and facilitators of sustaining EBF until 6 months postpartum.

Methods: Nine hundred forty-two pregnant women completed baseline and at least one of the five follow-up surveys: immediate (<7 days) (T1), 1 month (T2), 2 months (T3), 4 months (T4), and 6 months postpartum (T5). The response rates were 81.0% (T1), 69.9% (T2), 67.3% (T3), 65.8% (T4) and 81.4% (T5). Eighteen participants and 6 partners participated in either individual or focus group interviews at 6 months postpartum.

Results: The quantitative study found that mothers who worked full-time, had attained lower levels of education, lacked breastfeeding experience, and had caesarean sections were less likely to practise EBF at 6 months postpartum. In contrast, mother-in-law's breastfeeding experience, higher breastfeeding intention and better breastfeeding knowledge were positively associated with EBF at 6 months postpartum. Qualitative data identified perceived insufficient breast milk and returning to work as the main barriers, while support from family was the key facilitator.

Conclusions: In addition to education and support for mothers, in order to sustain EBF, it is crucial to engage with family members and for workplaces to create more conducive environments.

Impact: This large-scale mixed methods cohort study describes mothers' feeding practices and perspectives from the immediate postpartum period until 6 months. Factors associated with EBF at 6 months included (1) mother and infant attributes, (2) workplace and employment, (3) family and community, and (4) health systems and services. Policies and strategies extending to family members, workplace and health system will create a more conducive environment for sustaining EBF.

Background: Critical congenital heart disease (CHD) is associated with poor neurodevelopmental outcomes and long-term psychosocial morbidity. The pre-natal environment is increasingly recognized as a critical effector. However, the association of specific placental lesions with fetal brain volume in CHD remains unexamined.

Methods: This was a multi-site prospective, nested case-control study, that recruited pregnant women with typical fetal development and prenatally diagnosed fetal CHD. Fetal brain MRI was performed at 32.8 ± 3.0 weeks gestation. Placentas were examined pathologically after delivery. Clinical characteristics were gathered from self-reports and medical charts. Multiple linear regression modeling was performed in R with p < 0.05 considered significant.

Results: Placental hypoplasia (weight <10th %ile) was associated with lower total fetal intracranial volume in CHD (p = 0.006) and combined (CHD + non-CHD) cohorts (p = 0.001). Maternal and/or fetal vascular malperfusion was also associated with lower total fetal intracranial volume in combined (p = 0.026), and non-CHD cohorts (p = 0.020). Presence of any placental pathology was associated with reduced total fetal intracranial volume (p = 0.047), an effect moderated by the presence of CHD (interaction term p = 0.037).

Conclusion: Placental hypoplasia, vascular malperfusion, and the presence of any placental pathology are associated with decreased total intracranial volumes in-utero. Fetuses with CHD and concomitant placental lesions appear particularly susceptible.

Impact: Placental vascular malperfusion is associated with reduced fetal intracranial volume. Placental hypoplasia (weight <10th %ile) is associated with smaller intracranial volumes in fetal congenital heart disease. Placental pathologies uniquely affect in-utero brain development in congenital heart disease. This study is the first to link fetal brain development to specific placental pathologies using standardized, reproducible criteria (Amsterdam) with comparative inclusion of a non-congenital heart disease cohort. Evidence builds that the in-utero environment impacts neurodevelopment in congenital heart disease; this study points to specific placental lesions that may mediate the pathophysiology underlying these observations.

After Neonatal Intensive Care Unit (NICU) discharge, vulnerable babies at risk of neurodevelopmental impairment and other chronic problems often require specialized follow-up care to monitor their development and address any potential issues. Typically, this involves multiple follow-up visits usually focused on neurodevelopment and growth. With advances in obstetric care, high-risk fetuses are being identified earlier, marking another timepoint in which personalized medicine can be delivered from before birth to after discharge including neuronicu care. Our program embeds this focus into a comprehensive, multi-disciplinary primary care model, which offers significant benefits for at-risk infants, and provides an integrated approach to their care. We present the benefits of integrating this model of care with other specialty clinic services into a cohesive, multi-disciplinary follow-up system that maximizes the potential for optimal care and outcomes. Through close collaboration of our multiple specialists at each point of the medical journey of each infant from "Fetus to Five," we describe our program where the priority is each child's needs to be met efficiently and comprehensively, as a pathway to thriving developmental outcomes and overall family satisfaction. IMPACT: The future of such comprehensive programs lies in expanding access to comprehensive, integrated care offering services that extend into adolescence and adulthood that supports NICU graduates throughout their lifespan, ensuring optimal health and developmental outcomes.

Background: Children with acute lymphoblastic leukemia (ALL) may develop hypoglycemia, potentially attributable to mercaptopurine (6-MP) during long-term maintenance chemotherapy. Since hypoglycemia is harmful to childhood neurodevelopment, it is necessary to examine its occurrence during chemotherapy with and without 6-MP beyond the maintenance stage for ALL, along with the risk factors.

Methods: ALL patients received CAM-1 regimen (cyclophosphamide, cytarabine, and 6-MP). 6-MP was randomized to conventional administration at night before bedtime (Group A) or in the afternoon between lunch and dinner (Group B). Children with acute myeloid leukemia received non-6MP-containing chemotherapy (Group C).

Results: Group C showed no hypoglycemia. Among patients on CAM-1, 33% developed hypoglycemia, 48% of whom were symptomatic. There was no significant difference in hypoglycemic incidence (P = 0.933) between Groups A and B. No further hypoglycemic episodes were observed after shortening overnight fasting period in most cases. Multivariate analysis identified young age, higher serum bilirubin levels, and longer overnight fasting as significant risk factors for hypoglycemia in children receiving 6-MP.

Conclusion: Hypoglycemia is also prevalent in children exposed to short-term 6-MP but not in those without such exposure. Shortening overnight fasting period, rather than changing 6-MP schedule, is more critical in preventing hypoglycemia in young children.

Impact: This study reveals that hypoglycemia occurs frequently in children with ‌short-term exposure to 6-MP‌, as documented for long-term exposure‌ in published literature. The data demonstrate that it is 6-MP that is directly associated with hypoglycemia. Prolonged durations of overnight fasting, especially in younger individuals with hepatotoxicity, constitute a risk factor for developing hypoglycemia. Shortening the overnight fasting period, rather than changing the 6-MP schedule, is critical to prevent hypoglycemia and adverse neurodevelopment in children, even if they are receiving short-term 6-MP treatment.

Background: Numerous methods are available for measuring body composition in infants, however, there is no consensus on which approach is preferred. The aim of this study was to identify one such method for a clinical and research setting.

Methods: A systematic search was conducted on PubMed, Embase, and Cochrane Library to identify studies that investigated the accuracy of body composition methods in full-term infants up to 2 years of age.

Results: Thirty out of 6643 identified records were included. Several anthropometric equations were investigated with inconsistent results. Dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) showed more comparable results to those assessed by air displacement plethysmography (ADP), when applying new techniques. Few studies assessed the accuracy of quantitative magnetic resonance (QMR), isotope dilution, and near-infrared spectroscopy (NIR); nonetheless, they all performed well against reference methods. ADP showed agreement compared to deuterium dilution, 3-compartment-, and 4-compartment-models on group-level; however, there were discrepancies when compared to DXA.

Conclusions: Anthropometry, DXA, BIA, and ultrasound showed varying results, highlighting the need for further research. QMR, isotope dilution, and NIR appeared promising, but evidence is limited due to few studies. ADP showed consistently small bias compared to multi-component models and isotope dilution.

Impact: Accurate body composition assessment in infancy has the potential to improve prophylactic actions against obesity. There is relative consensus on the most accurate body composition assessment in pre-term infants in a research setting, however, this consensus has not been available for full-term infants until now. Measure of anthropometry performs with varying precision, suggesting very low feasibility of the method for body composition assessment. From a research perspective, air displacement plethysmography is an accurate method for measuring body composition in full-term infants. This systematic review identifies research gaps within the scientific field of infant body composition.

Critically ill preterm and term neonates are uniquely vulnerable to and constantly confront potential harmful and unintended exposures in every aspect of their care, including diagnostic imaging, sensory environments, medications, nutrition, blood products, and device exposures. The rapidly changing pathology, physiology, and metabolism of these infants, along with a lack of treatments tailored to the needs of neonates, lead to unintended negative consequences with impacts reaching far out into adulthood. Families, nurses, clinicians, and researchers provide the best care for neonates with the resources and knowledge available, but more needs to be done from the healthcare policy and societal levels. More research is needed to understand the negative impacts of environmental exposures on neonates and children in general. Concerted efforts should focus on eliminating known toxic and harmful substances from commercial products used in neonatal care, and alternatives should be made available. Resource allocation is needed by community leaders and health policy makers, through regulations and incentives, to ensure that neonates and children can have healthy, happy, and productive lives. Our society should be judged by how we care for and treat this most vulnerable population, who deserve environments and treatments free from unintended, unnecessary harmful exposures. IMPACT: Technological advances have significantly improved survival of critically ill term and pre-term infants, but pose a unique challenge of exposure to multiple environmental toxins. In this review, we have summarized these exposures and the pathways through which they may negatively impact the neurodevelopmental outcomes in this highly vulnerable population. Ongoing environmental exposures in the NICU are a global healthcare problem and need policies and resources in place to mitigate their negative impact on infant and child health outcomes.

Background: Umbilical cord blood (UCB) is increasingly studied for regenerative therapies, yet the impact of different collection techniques on cell yield and quality remains unclear. This study compared standard needle-and-bag UCB collection with manual cord milking, performed both in utero (placenta attached) and ex utero (placenta delivered), using samples from healthy term infants ( > 37 weeks gestation).

Method: Forty-two samples (n = 10 standard in utero, n = 10 standard ex utero, n = 10 milking in utero, n = 12 milking ex utero) were analyzed for blood volume, mononuclear cell count, and cellular composition via flow cytometry. Key cell populations included hematopoietic stem cells (CD34 + CD45 + ), endothelial progenitor cells (CD45 + CD34 + CD31 - CD133 + ), and mature endothelial cells (CD34 - CD45 - CD31 + ). Plasma cytokines, including inflammatory and angiogenic markers, were also assessed.

Results: No significant differences were found in total blood volume or mononuclear cell counts across groups. However, endothelial progenitor cell viability was significantly reduced in cord milking ex utero compared to standard in utero collection (p < 0.0001). Cytokine analysis showed elevated IL-1RA and reduced VEGF-A in cord milking ex utero samples (p < 0.0001 and p = 0.0004, respectively).

Conclusion: These findings suggest that in utero cord milking may be a viable alternative to standard UCB collection, preserving cell viability and cytokine integrity.

Impact: The standard method for collecting umbilical cord blood (UCB) has limitations, especially in cases like premature birth, where low volumes yield insufficient mononuclear and hematopoietic stem cells for therapeutic use. This study evaluated an alternative technique-umbilical cord milking-against the standard approach. As the first study to assess its efficacy for UCB collection, the findings offer insights into a viable alternative method.