Pediatric Research最新文献

Background: Many preterm infants need nutrition beyond 24 kcal/oz (standard fortification) to support growth. Individualized targeted fortification improves growth but is labor-intensive. Universal enhanced fortification to presumed 26 kcal/oz for very low birth weight infants was clinically implemented. We determined how often donor breast milk (DBM) and preterm maternal breast milk (MBM) met nutritional targets with enhanced fortification.

Methods: MBM/DBM samples were collected for a prospective cohort study of infants born <1500 g and <33 weeks. Macronutrients were measured using a mid-infrared analyzer. The frequency at which MBM/DBM samples met intake goals (4.8-8.1 g/kg/day fat, 11.6-13.2 g/kg/day carbohydrate, 3.5-4.5 g/kg/day protein) with enhanced and standard fortification was compared.

Results: Among 198 MBM samples and 168 DBM samples, MBM had higher protein, fat, and energy (p < 0.0001). Regardless of fortification method, MBM samples met lower and mid-range fat goals more often (p < 0.01 and p = 0.03, respectively). Collectively, more samples achieved protein targets with enhanced fortification: all samples reached 3.5 and 4 g/kg/day, 56% (147 MBM, 58 DBM) attained 4.5 g/kg/day. With standard fortification, 11% achieved 4 g/kg/day protein; none attained 4.5 g/kg/day.

Conclusions: Enhanced fortification is an efficient method that meets enteral nutrition goals for preterm infants and delivers desired protein intake more consistently.

Impact: Enhanced fortification is a feasible and efficient alternative to targeted fortification that can also achieve enteral nutrition goals for preterm infants. Enhanced fortification delivers desired protein intake more consistently than standard fortification, especially with donor breast milk. Regardless of fortification strategy, maternal breast milk is more likely to reach fat intake goals, although additional enrichment may be needed, depending on the fortifier product.

Survival rates of preterm infants have been steadily increasing over the last few decades. This has drawn long-term outcomes in this population to the forefront of scientific attention. Caffeine is a pharmacological agent that is available to neonatologists in the treatment of apnoea of prematurity. Its use for this condition has been well researched; however, less focus has been directed towards its neuroprotective capabilities. Long-term follow-up from the landmark 'Caffeine Therapy for Apnoea of Prematurity' trial suggested that caffeine may confer benefits in neurodevelopmental outcomes. The indirect ways in which caffeine could confer these benefits have been extensively discussed; however, the direct molecular mechanisms by which this is achieved are poorly understood. This article reviews the putative mechanisms through which caffeine acts as a neuroprotectant in the preterm infant. Caffeine may directly confer neuroprotective benefits through altering white matter structures, reducing inflammation, preventing cell death and conferring neuromodulatory benefits. With the rise in preterm birth and the need for effective neuroprotective therapies, caffeine's multifaceted mechanisms offer promising avenues for future research and clinical application. IMPACT: This article adds to the existing literature by which it: reviews the putative mechanisms through which caffeine acts as a neuroprotectant hypotheses that caffeine confers neuroprotective benefits through altering white matter structures, reducing inflammation, preventing cell death, and conferring neuromodulatory benefits, and consolidates evidence regarding caffeine's impact on neurodevelopmental outcomes.

Background: Elevated pre-pregnancy body mass index (BMI) and perinatal depressive symptoms have been linked to neonatal alterations in brain structure and function. This study examined associations between neonatal functional brain dynamics, maternal BMI, and perinatal depressive symptoms measured by the Edinburgh Postnatal Depression Scale (EPDS) in a community-based, largely low-risk cohort.

Methods: Funcitonal MRI and Leading Eigenvector Analysis (LEiDA) were applied in a neonatal cohort (N = 437; 236 males; mean gestational age 39.6 weeks) from the developing Human Connectome Project. We assessed whether neonatal brain-state probabilities related to maternal BMI and EPDS scores (M = 5.6, SD = 4.3), testing main effects and, separately, their interaction. The sample included 291 healthy-weight (BMI < 25), 98 overweight (25 BMI < 30), and 48 obese (BMI 30) mothers.

Results: EPDS scores were low in this cohort and did not demonstrate associations with brain states or a significant BMI × EPDS interaction. Higher maternal pre-pregnancy BMI was negatively associated with the stability of a functional network encompassing superior frontal, superior parietal, and temporal regions (ß = -0.129, p = 0.006).

Conclusion: As this network is normally recruited more with age, reduced stability suggests slowed maturation of fronto-parieto-temporal systems and may signal early risk for later behavioral challenges.

Impact: Higher maternal pre-pregnancy BMI is associated with reduced stability in a neonatal frontoparietal brain state, characterized by coordinated activity in frontal, parietal, and temporal regions. This state is one of six distinct dynamic connectivity patterns identified, reflecting core neonatal resting-state networks. The association was robust across multiple analytic models and clustering solutions. No significant effects were found for maternal depressive symptoms. These findings underscore the selective impact of maternal metabolic health on early brain organization, suggesting prenatal influences on the functional architecture of the newborn brain that may shape long-term neurodevelopmental trajectories.

Background: Exposure to unconventional hydraulically fractured oil and gas wells during pregnancy is associated with a higher risk of structural birth defects. These associations have not been examined in California, where most operators use conventional methods that do not use enhanced techniques.

Objectives: Determine whether residing near oil and gas wells during early pregnancy was associated with birth defect risks among San Joaquin Valley, California, residents.

Methods: We conducted a case-control study with data from the California Center of the National Birth Defects Prevention Study for births delivered from 1997-2011. We considered 16 structural birth defect phenotypes. We assessed exposure to active wells within 3 km of the maternal residence or inactive wells within 1 km. We fit adjusted logistic regression models for each exposure and birth defect phenotype.

Results: Exposure to active wells was associated with elevated odds of some CHDs and significantly lower odds of atrial septal defect secundum and gastroschisis. Exposure to inactive wells was associated with significantly elevated odds of cleft palate.

Conclusions: Among San Joaquin Valley residents, living near active and inactive wells was associated with risks of birth defects. The estimates were imprecise and, given the number of statistical tests we conducted, may be spurious.

Impact: Researchers have not yet characterized structural birth defect-related potential risks associated with living near conventional wells in California, and there is little understanding of the hazards associated with inactive wells. We found that living near active wells in the San Joaquin Valley, California, was associated with risk of some structural birth defects, but findings were imprecise. Living near inactive wells was associated with an elevated risk of cleft lip and cleft palate. Further research could help determine whether findings were valid and explicate plausible etiological pathways.

Neuroplasticity, the brain's adaptive ability to restructure and reorganize itself, represents one of the most fascinating aspects of the developing brain. Neuroplasticity is maximal during the "first 1000 days" (conception through two years of life), presenting both unique opportunities and vulnerabilities. While neonatal neurology often focuses on the "symptomatic minority" presenting early after birth, there remains an "unrecognized majority" of children who will present with disorders later in childhood. For clinicians working with newborns and young infants, a comprehensive understanding of developmental principles provides the foundation for knowledge to optimize early intervention strategies. This review focuses on the biological basis of neuroplasticity and metaplasticity in the neonatal brain, as well as their role in neurodevelopment. We examine how the "dynamic neural exposome" (the full mix of biological and environmental influences the brain is exposed to over time) and "toxic stressor interplay" (the combined effect of multiple stressors such as pain, infection, and inflammation) influence these processes, often leading to "ontogenetic adaptations" (short-term survival-driven changes in brain wiring that may have long-term consequences). We outline mechanisms shaping early brain development, describe how early experiences and interventions influence outcomes, and emphasize prioritizing prevention over later rescue to improve neurodevelopmental outcomes. IMPACT: The article provides a high-level framework that links the brain's response to experience and injury directly to clinical implications in neonatology, expanding the focus to the "first 1000 days". The effectiveness of interventions hinges on their timing relative to developmental critical and sensitive periods, alongside the dynamic interplay between genetic and environmental influences (including the Maternal-Placental-Fetal triad) on brain development. Neuroplasticity presents both a window for recovery and adaptation, and a susceptibility to adverse experiences, emphasizing the need for evidence-based neuroprotective and neurodevelopmental care that prioritizes preventive approaches to improve long-term outcomes.

Background: The lack of centralized pediatric critical care data in Kuwait has limited benchmarking, outcome evaluation, and resource planning. This study describes the development and implementation of Kuwait's first nationwide PICU registry and evaluates its feasibility and early utility.

Methods: A centralized registry was implemented across seven governmental PICUs serving over 870,000 children. Demographics, diagnoses, interventions, outcomes, and infection data were retrospectively collected at discharge by site coordinators. Data were entered into a secure, encrypted platform using de-identified records and role-based access, with centralized validation performed every tercile.

Results: During the implementation phase, 2086 of 2364 admissions were captured. Registry accuracy compared with manual admission logs was 88.2%, demonstrating feasibility and data reliability. Inter-hospital variability in clinical practices and resource utilization was identified. The registry also enabled early detection of infection trends and supported proactive staffing and equipment planning.

Conclusion: Kuwait's national PICU registry is feasible, reliable, and operationally effective. It addresses critical data gaps, enhances transparency, supports evidence-based decision-making, and provides a foundation for national quality improvement and future benchmarking initiatives.

Impact: Demonstrates feasibility, reliability, and operational effectiveness of a national PICU registry in real-world pediatric critical care. Enables early detection of infection trends and supports strategic planning for staffing and equipment. Presents one of the first national PICU registry models in the Middle East, addressing fragmented data systems. Offers practical strategies for standardization, data validation, and inter-hospital coordination, supported by physician champions and stakeholder engagement. Bridges critical data gaps, strengthens quality monitoring and benchmarking, and provides a scalable framework for broader pediatric specialties and international research.

Background: The COVID-19 pandemic has altered the typical annual pattern of influenza. We aim to assess its impact on influenza outcomes, especially on mortality, cardiovascular, and non-cardiovascular complications.

Methods: This study utilized discharge records from the National Inpatient Sample (NIS) for 2019 and 2022. We analyzed the data of hospitalized influenza patients (20 years and younger) using descriptive statistics and logistic regression models.

Results: 29,270 influenza hospitalizations were identified in the pre-pandemic year and 29,860 in the post-mitigation year. The median age was 6 years (IQR: 2-12) in the post-mitigation year vs. 4 years (IQR: 1-9) in the pre-pandemic year, P < 0.001. Mortality and major cardiovascular complications, including myocarditis and tachyarrhythmias, showed no differences. Respiratory failure was more common in post-mitigation (21.4% vs. 12.7%), with nearly twice the risk in adjusted models [aOR = 1.92 (1.68-2.19), P < 0.001]. Invasive mechanical ventilation use decreased in the post-mitigation year by 30% [aOR = 0.7 (0.55-0.89), P = 0.004].

Conclusion: Mortality and cardiovascular complications remained stable in pre- and post-mitigation year; however, post-pandemic influenza showed an increased risk of respiratory failure with a decreased invasive mechanical ventilation use. This suggests a shift in disease presentation and clinical management strategies in the post-mitigation period.

Impact: Influenza's clinical profile in children has changed post-COVID, with increased respiratory failure and a shift to older affected age groups, while mortality and severe cardiovascular complications remain stable. This study is the first to systematically compare pediatric influenza outcomes, including all major complications and mortality, pre- and post-COVID-19, revealing specific shifts in disease presentation and demographics. Informs clinical vigilance, diagnostic strategies, and public health planning for pediatric influenza by highlighting shifts in hospitalization patterns and complications observed during the post-mitigation period. Findings support preparedness efforts recognizing temporal disruptions surrounding the pandemic.