Pediatric Research最新文献

Background: To investigate the longitudinal effects of obesity on change in lung function after 1 year of follow-up in obese children and adolescents.

Methods: Obese children/adolescents aged 8-15 years with pulmonary function test (PFT) results and recorded anthropometric obesity indices from 1 year earlier for comparison were recruited. Multiple linear regression of change in each lung function parameter was applied to determine the effect of sex, change in body mass index (ΔBMI), change in chest circumference (ΔCC), change in waist circumference (ΔWC), and change in waist circumference-to-height ratio (ΔWC/Ht).

Results: Sixty-six children/adolescents (mean age: 12.5 ± 2.6 years) were recruited. Multiple linear regression analysis showed that ΔWC negatively affects the ratio of the forced expiratory volume in the first 1 s to the forced vital capacity of the lungs Δ(FEV₁/FVC) (b = -0.3, p = 0.002), forced expiratory flow rate within 25-75% of vital capacity (ΔFEF_25-75%) (b = -0.92, p = 0.006), and Δ(FEF_25-75%/FVC) (b = -0.99, p = 0.003). When replacing ΔWC with Δ(WC/Ht) as the independent variable, Δ(WC/Ht) also negatively affects Δ(FEV₁/FVC) (b = -33.71, p = 0.02), ΔFEF_25-75% (b = -102.9, p = 0.03) and Δ(FEF_25-75%/FVC) (b = -102.7, p = 0.03).

Conclusion: After 1 year of follow-up, change in abdominal adiposity determined by WC and WC/Ht exerted significant negative effect on lung function change specific to FEV₁/FVC, FEF_25-75% /FVC, and FEF_25-75%.

Impact: Longitudinal effects of change in obesity on lung function in obese children and adolescents are evidenced. Change in waist circumference or waist-to-height ratio, which indicates abdominal adiposity, was inversely correlated with a change in FEV1/FVC, FEF25-75% /FVC, and FEF25-75% in children and adolescents with obesity after 1 year of follow-up. Our results suggest using waist circumference and/or waist-to-height ratio in addition to BW and/or BMI for monitoring obesity. Fat loss programs, especially those focused on reducing abdominal adiposity should be encouraged to prevent late lung function impairment.

Background: Steroid treatment is well-known for producing clinically significant improvements in respiratory support requirements. In this study, we utilized lung ultrasound and respiratory oscillometry to objectively assess this response and determine if the combination of these methods can serve as a valuable tool for comparing different treatment strategies.

Methods: We conducted a retrospective observational study including preterm infants with a gestational age below 32 weeks and/or a birth weight below 1500 g. We measured lung ultrasound score (LUS) and respiratory system reactance (Xrs) by respiratory oscillometry before and after treatment with either systemic dexamethasone or inhaled budesonide.

Results: We analyzed 46 treatments (9 dexamethasone, 37 budesonide) administered to 40 infants (median (Q1, Q3) postnatal age = 30 (18, 49) days, postmenstrual age = 33.29 (30.14, 35.00) weeks). All treatments were associated with a notable reduction in respiratory support and a concurrent improvement in either Xrs, LUS, or both. On average, Xrs improved from 3.13 (1.09, 5.41) to 0.44 (-0.90, 1.59) z-score (p < 0.001) and LUS from 10 (7, 12) to 5 (3, 8) (p < 0.001).

Conclusions: Xrs and LUS proved sensitive to lung function changes associated with corticosteroids; combining the two better described the response and its variability.

Impact: We found that respiratory system reactance (Xrs) and lung ultrasound score (LUS) are sensitive biomarker for monitoring changes in lung function associated with corticosteroids; Combining Xrs and LUS enhances evaluation compared to each method alone; These results have valuable implications in clinical practice, particularly in personalizing and monitoring corticosteroid treatment; The present paper suggests that the combined use of respiratory oscillometry and lung ultrasound holds value as a research tool in future studies investigating various treatment regimens, molecules, or administration routes.

Background: Infantile colic may represent gastrointestinal distress, yet most definitions emphasize excessive crying. Each may have distinct etiologies.

Design/methods: In a pre-birth cohort, we used maternal reports of infant crying and apparent abdominal discomfort at 6mos to categorize infants as (1) unaffected (no excessive crying or colic), (2) excessive crying only, and (3) colic (abdominal discomfort +/- excessive crying). We examined associations of potential risk factors in separate models with excessive crying and colic (each vs. unaffected) using unadjusted multinomial logistic regression, and associations between count of risk factors and colic using logistic regression.

Results: Of 1403 infants, 140 (10%) had excessive crying, and 346 (25%) colic. Infants that were non-Hispanic white, low birthweight, firstborn, or had a maternal history of atopy, high postpartum depressive symptoms, or persistent prenatal nausea, had a 40-80% higher relative risk of colic. Preterm birth was associated with double the risk. Being firstborn, low birthweight, and preterm birth predicted excessive crying. Infants with ≥four (vs. 0-1) of the seven identified risk factors had 3.9 times (95% CI: 2.6, 6.1) higher odds of colic.

Conclusions: Colic characterized by apparent abdominal discomfort can be phenotypically distinguished from excessive crying only. Multiple risk factors may further increase colic risk.

Impact: Infant colic characterized by apparent gastrointestinal distress may be phenotypically distinct from excessive crying only. Literature that defines colic only based on crying behaviors may miss important predictors. Mother-reported colic and excessive crying appear to have overlapping risk factors, with additional risk factors identified for colic. The presence of multiple risk factors increases the risk of colic, supporting a multifactorial etiology.

Background: Kangaroo mother care (KMC) is WHO-recommended for low-birth-weight infants, yet its impact on autonomic cardiovascular control in preterm foetal growth-restricted (FGR) infants remains unclear. We hypothesised that KMC would promote autonomic cardiovascular control, benefiting preterm FGR infants with reduced baseline autonomic function compared to appropriate for gestational age (AGA) infants.

Methods: Autonomic control was assessed via heart rate variability (HRV) in low frequency (LF) and high frequency (HF) bands using spectral analysis. Preterm FGR (n = 22) and AGA (n = 20) infants were assessed for 30-min before and 60-min during KMC. Comparisons were made between FGR and AGA infants; and between infants with baseline HRV below and above median.

Results: Overall, no significant HRV changes were observed during KMC for FGR or AGA infants compared to baselines. Infants with low baseline HRV LF showed increased HRV during KMC (p = 0.02 and 0.05 for the entire group and FGR group, respectively). This effect was absent in the AGA group regardless of baseline HRV. Infants with high baseline HRV had decreased HRV during KMC.

Conclusions: Infants with low baseline HRV, suggesting reduced autonomic control, are more likely to benefit from KMC with increased HRV. Further, this effect is stronger in FGR than AGA infants.

Impact: Kangaroo mother care (KMC) is WHO-recommended for low-birth-weight infants, yet its impact on autonomic cardiovascular control in preterm foetal growth-restricted (FGR) infants is unclear. Preterm infants with low baseline heart rate variability (HRV) are more likely to benefit from KMC and increase their HRV suggesting improved autonomic control. This effect is stronger in preterm FGR infants than those with appropriate growth for age.