Pediatric Research最新文献

Background: Rapid weight gain (RWG) in early life is a significant risk factor for childhood obesity. Its multifactorial etiology warrants exploratory statistical and machine-learning analysis to aid early prediction.

Methods: Data from a prospective infant study were used to compare four models for predicting RWG from birth to 6 months: two machine‑learning methods (SVM with a linear kernel and Naïve Bayes), one regularized regression (LASSO), and one traditional statistical model (Generalized Linear Model, GLM). Performance was evaluated using AUC, accuracy, precision, sensitivity, specificity, and F1‑score, each with 95% confidence intervals (CI).

Results: Precision was comparable across models (0.70-0.75). The GLM showed the highest point estimates for AUC (0.66, 95% CI 0.48-0.83), specificity (0.45, 95% CI 0.37-0.53), accuracy (0.72, 95% CI 0.53-0.86), and F1‑score (0.800), while LASSO achieved the highest sensitivity (0.91, 95% CI 0.84-0.95). However, all CIs overlapped, indicating no statistically significant differences.

Conclusion: Although the GLM had the highest point estimates, all models showed similar and modest discriminative ability. Consistent early‑life predictors emerged across approaches, highlighting the multifactorial nature of RWG. Larger cohorts are needed to improve predictive accuracy and fully assess machine‑learning methods.

Impact: Rapid weight gain (RWG) results from the dynamic interplay of biological, dietary, behavioral, and environmental factors. Developing robust models to identify key determinants is therefore essential. In this study, the GLM yielded the highest point estimates across key metrics, while the machine‑learning models nonetheless demonstrated promising potential. Predictive modeling in this context not only enables risk stratification but also provides insight into underlying mechanisms, thereby guiding future longitudinal research and informing preventive strategies to support healthy growth trajectories in early life.

Background: Early antibiotic exposure has been associated with increased weight gain in children. Evidence associating the timing of antibiotic exposure to overweight and obesity is limited.

Methods: This population-based cohort study included 33,095 vaginally delivered children with 595,213 growth measurements linked to medical records and national registers. Exposures included antibiotic exposure during the year before pregnancy, during pregnancy, in the perinatal period, and within the first 24 months of life. The primary outcomes were zBMI at 24 months of age and the cumulative incidence of overweight and obesity up to 12 years of age.

Results: Antibiotic exposure before or at birth was not associated with childhood overweight or obesity. Exposure during the first 24 months of life was linked to a higher zBMI at two years of age. Long-term analysis revealed an adjusted hazard ratio of 1.09 (95% CI 1.04-1.13) for overweight and 1.20 (95% CI, 1.10-1.31) for obesity.

Conclusion: Antibiotic exposure during the first two years of life was associated with childhood overweight and obesity. No similar associations were observed for exposure before or at birth. Interventions aiming to reduce obesity-related effects should focus on minimizing early-life antibiotic use within the first two years of life.

Impact: Early-life antibiotics have been associated with childhood overweight and obesity. We investigated how the timing of early-life antibiotic exposure is associated with childhood overweight and obesity. Antibiotic exposure in the first two years of life was associated with overweight and obesity. No similar associations were found with antibiotic exposure before pregnancy, during pregnancy, or in the perinatal period. Interventions aiming to reduce obesity-associated effects should focus on the first two years of life.

Background: A quadrivalent meningococcal tetanus toxoid-conjugate vaccine, MenACYW-TT, was developed to provide broad protection against invasive meningococcal disease across all age groups. We evaluated the immunogenicity and safety of MenACYW-TT as a two-dose series (1 + 1 schedule) co-administered with routine pediatric vaccines to infants from 6 months of age.

Methods: This phase III modified double-blind, randomized study (NCT03691610) enrolled healthy infants (n = 750) and toddlers (n = 200). Infants were randomized 1:1 to receive MenACYW-TT (Group 1) or another quadrivalent conjugate vaccine, MenACWY-CRM (Group 2) at ages 6-7 and 12-13 months, co-administered with routine vaccines. Toddlers were randomized 1:1 to receive MenACYW-TT (Group 3) or another quadrivalent conjugate vaccine, MenACWY-DT (Group 4) at ages 17-19 and 20-23 months. Functional antibodies against the four meningococcal serogroups were assessed by serum bactericidal antibody assay using human complement (hSBA). Safety was assessed up to 6 months post-vaccination.

Results: Seroresponse to MenACYW-TT was non-inferior to that with MenACWY-CRM against all four serogroups (seroresponse rates 30 days post-dose 2 were 89.4-99.3% and 82.9-97.7%, respectively). All vaccines were well tolerated.

Conclusions: These findings support MenACYW-TT administration as a two-dose series in children from 6 months of age.

Study registration: Clinicaltrials.gov: NCT03691610.

Impact: When administered as a two-dose series (1 + 1 schedule), MenACYW-TT demonstrated comparable/higher immunogenicity to MenACWY-CRM (ages 6-7 and 12-13 months) and the safety profiles of these quadrivalent meningococcal vaccines were similar. MenACYW-TT was non-inferior to MenACWY-CRM in terms of seroresponse rates and proportion of participants with antibody titer ≥1:8 after a second dose at age 12-13 months. This phase III study is the first to confirm the safety and immunogenicity of MenACYW-TT in infants and supports its use as a two-dose series from 6 months of age.

Background: Congenital hearing loss can significantly affect childhood development, yet more than half of affected infants present without identifiable risk factors. A possible association between maternal diabetes and congenital hearing loss has been suggested, although existing evidence is inconsistent. This study examined the relationship between Gestational Diabetes Mellitus (GDM) and congenital hearing loss in term infants using population-level data from Queensland, Australia.

Methods: A cross-sectional data-linkage study was conducted using the Queensland Perinatal Data Collection and the QChild newborn hearing screening database from 2014 to 2019. The cohort included term infants ( > 37 weeks) born in Queensland hospitals. Hearing outcomes were linked to maternal and perinatal variables. Multivariable regression models were used to adjust for known risk factors.

Results: Among 330,778 mother-infant pairs, 11.8% were exposed to GDM. Congenital hearing loss occurred in 0.3% of infants overall, including 13.7% of those exposed to GDM. No significant association was identified between GDM and congenital hearing loss (aOR 1.09; 95% CI 0.90-1.31). Unadjusted analyses suggested higher odds of severe, retrocochlear, and structural hearing loss subtypes among exposed infants.

Conclusion: GDM was not associated with congenital hearing loss in term infants in this large, population-level cohort. However, heterogeneity across specific audiological phenotypes warrants further investigation.

Impact: No significant association between Gestational Diabetes Mellitus (GDM) and congenital hearing loss in term infants was found in a setting with universal health care and population screening for both In this context clinicians can be reassured that GDM alone is not associated with increased risk for congenital hearing loss, supporting current screening protocols and resource allocation. In this context clinicians can reassure families that congenital hearing loss due to exposure to GDM alone is unlikely.