Pediatric Research最新文献

Background: Pediatric screening for household tobacco smoke exposure (TSE) may help to increase parental access to tobacco treatment and reduce childhood TSE, yet levels remain low. This study aimed to characterize sociodemographic and visit-related factors associated with TSE screening in pediatric primary care.

Methods: Secondary analysis of electronic health records for all clinic visits (patients 0-18 years) in a metropolitan health system. Modified Poisson regressions examined the association between patient and visit characteristics and TSE screening.

Results: TSE screening was documented in 84% of all visits (n = 62,161 patients). TSE screening was more likely among patients who were 3 years or older (3-6 years PR 1.40, 95% CI 1.37, 1.42; 7-12 years PR 1.40, 95% CI 1.38, 1.43; 13+ years PR 1.49, 95% CI 1.47, 1.52), patients with insurance (PR 1.05, 95% CI 1.03, 1.08), and those with a diagnosis of reactive airways disease, bronchiolitis, or wheeze (PR 1.07, 95% CI 1.06, 1.08) or preterm birth (PR 1.04, 95% CI 1.03, 1.06).

Conclusion: Pediatric patients with high-risk medical diagnoses were more likely to receive recommended household TSE screening. There are opportunities within pediatric primary care to increase screening for household TSE among younger and underinsured pediatric populations.

Impact: Pediatric patients with high-risk medical diagnoses were more likely to receive recommended household TSE screening. Levels of household TSE screening were lowest among patients age 2 years and under and those who are underinsured. Increasing systematic screening for household TSE is essential to connect parents who smoke with resources to quit.

Background: We investigated the associations of genetic risk score for Alzheimer's disease (GRS-AD) with cardiometabolic risk from early childhood over a 20-year follow-up.

Methods: The STRIP study included 1062 children at baseline. GRS-AD was calculated for 631 participants using 22 independent genetic risk variants, including APOE ε2 and ε4 alleles, and excluding them (non-APOE-GRS-AD). We repeatedly measured waist circumference, high-density (HDL-C) and low-density (LDL-C) lipoprotein cholesterol, triglycerides, glucose, insulin, and blood pressure. The data were analysed with generalised additive mixed models.

Results: GRS-AD was directly associated with serum LDL-C (unstandardised β = 0.140, 95% CI = 0.084 to 0.195) and inversely with HDL-C (β = -0.026, 95% CI = -0.044 to -0.009). GRS-AD was inversely associated with serum HDL-C in males (β = -0.044, 95% CI = -0.070 to -0.018) but not in females (β = -0.010, 95% CI = -0.032 to 0.012). The associations were diluted when the non-APOE-GRS-AD was applied.

Conclusion: A genetic predisposition to AD may alter lipid metabolism from early childhood.

Impact: While Alzheimer's disease and cardiometabolic diseases may have shared genetic determinants, the associations between genetic susceptibility for Alzheimer's disease and increased cardiometabolic risk from childhood to young adulthood are poorly understood. We investigated the associations of genetic risk score for Alzheimer's disease with cardiometabolic risk from early childhood over a 20-year follow-up. We found that a higher genetic risk score for Alzheimer's disease was associated with higher LDL cholesterol, non-HDL cholesterol, and ApoB, and with lower serum HDL cholesterol and ApoA1. These findings suggest that a genetic predisposition to Alzheimer's disease may alter lipid metabolism from early childhood.

Background: In France, following the first confinement related to the Covid-19 pandemic, strict government health guidelines aimed at limiting the spread of the disease disrupted the daily lives of children, particularly those with neurobehavioral disorders related to prematurity, which could affect their quality of life (QoL).

Methods: An observational, cross-sectional study was conducted to compare the QoL of children born very-prematurely (VP) with dysexecutive disorder, aged 7 to 9, with that of a control group of school-age children born at term of the same age, during the 6-month post-confinement period.

Results: A total of 142 children were included, 70 VP and 72 at term. There was no change in self-reported QoL in the social domains (leisure, vitality, relationships with friends and/or family) in the VP group. However, the QoL was decreased in the control group. Parents reported a negative change in the same social domains for both groups.

Conclusions: Social isolation measures during the Covid-19 had a negative impact on well-being of typically developing control-group children, whereas children born VP with specific social cognition disorders were little affected. Conditions of social isolation during Covid-19 reproduce the sociability problems experienced by children born VP due to face and emotions recognition disorders.

Impact: School-age children born very prematurely with dysexecutive disorders considered that the social distancing measures introduced during the pandemic (Covid-19) did not impact their quality of life when they returned to school, unlike school-age children born at term. Facial and emotion recognition disorders inherent in very preterm birth were minimized by social distancing measures. Identifying an impairment risk of specific social reasoning in premature children should enable the implementation of early circumvention measures from neonatology onwards, with the aim of minimizing its impact.

Background: This study investigated behaviour in children with complex congenital heart disease (cCHD) from preschool to adolescence and identified predictors for normal behaviour.

Methods: Parent-reported behaviour of 137 children with cCHD was assessed at ages 4, 6, 10, and 13 years and compared to norms. Latent class growth analysis (LCGA) identified distinct behavioural trajectories. Predictors of normal behaviour and adolescent outcomes (self-reported quality of life [QoL], special educational needs [SEN]) were examined by LCGA-defined trajectory groups.

Results: Compared to norms, children with cCHD had more emotional problems at 6 years, and more emotional problems, hyperactivity, and total behavioural problems at 13 years of age (all p < 0.05). LCGA identified Class 1 with increasing problems with age (26%,p_slope < 0.001), Class 2 with early problems improving with age (18%,p_slope < 0.001) and Class 3 with normal behaviour across ages (55%,p_slope = 0.28). Higher child IQ (OR = 1.1,p = 0.020) and better maternal mental health (OR = 0.9,p = 0.004) at 4 years predicted normal behaviour. Normal behaviour was linked to less SEN (p < 0.001), but not significantly to QoL (p = 0.059).

Conclusion: A subgroup of patients with cCHD demonstrates behavioural problems over time. Higher IQ and better maternal mental health predict favourable behaviour. These findings underscore the importance of neurodevelopmental follow-ups and family-centred care to identify and support children at-risk.

Impact: Behavioural outcomes in patients with complex congenital heart disease (cCHD) are highly heterogenous both between patients and over time. This study identified distinct subgroups of behavioural trajectories, including one with increasing difficulties over time, one with decreasing difficulties, and one without persistent problems. Children with cCHD with behavioural problems also frequently require special educational needs. Higher child IQ and better maternal mental health during preschool predicted favourable behavioural outcomes over time. Repeated neurodevelopmental follow-ups into adolescence and the implementation of family-centred care are key to identify at-risk individuals and support long-term outcomes in cCHD.

Background: Children with complex congenital heart disease (cCHD) are at risk for neurodevelopmental impairments (NDI). This study aims to examine the proportion of school-age children with cCHD who exhibit no NDI and to identify protective factors.

Methods: Outcomes of five neurodevelopmental domains were assessed longitudinally in children with cCHD. For this retrospective analysis of prospectively collected data, survival without impairments was defined as scores within 1 SD or above 10^th percentile, for each domain. Regression analyses were conducted to identify protective factors and to investigate associations between number of impaired domains and the need for therapies and educational support.

Results: Mean outcomes were within the normal range except for motor skills (z = -1.5, SD = 1.6). At age 10, 77.9% of 113 children showed impairments in at least one domain; only 22.1% had none. Having impairments in more domains was associated with higher rates of educational support (p = 0.04). Higher socioeconomic status (SES) (p = 0.02) and motor (p = 0.004) scores at 4 years predicted better outcomes.

Conclusions: Despite mostly normal average outcomes, only one quarter of children with cCHD remain free of NDI by age 10. Higher SES and early motor functions predict survival without impairments, highlighting the importance of ongoing monitoring and intervention.

Impact: Only one quarter of children born with complex congenital heart disease remain free of neurodevelopmental impairments at school age. 42.5% of school-age children with complex CHD show neurodevelopmental impairments in multiple domains, highlighting the need for ongoing monitoring and intervention to improve outcome. Socioeconomic status and early motor outcomes predict later survival without neurodevelopmental impairments.