Pediatric Research最新文献

Background: Compromised myocardial function and persistent elevated pulmonary vascular resistance are common among neonates treated with therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). There is a lack of data regarding persistence of cardiac alterations after discharge from the neonatal intensive care unit (NICU).

Methods: We assessed cardiovascular profiles after NICU discharge. Echocardiogram data, including speckle-tracking echocardiography (STE), were extracted from the latest outpatient scan. Data were compared by initial amplitude-integrated encephalography (aEEG) profiles on admission [normal vs. abnormal].

Results: In total, 70 (19%) neonates had a follow-up echocardiogram (22 with initial normal aEEG, 48 with abnormal aEEG). Age at follow-up was similar between the two groups (6.2 vs. 7.7 months, [p = 0.08]). Neonates with an initially abnormal aEEG showed more negative Right Ventricle (RV)-peak global longitudinal strain (-28.2 vs. -26.0%, [p = 0.02]), RV-peak free wall longitudinal strain rate (-1.24 vs. -1.10 [1/second], [p = 0.01]), and RV-peak free wall longitudinal strain rate (-1.50 vs. -1.27 [1/second], [p = 0.001]). These associations remained after multilinear regression analysis, indicating persistent enhanced RV contraction in the abnormal aEEG group.

Conclusion: Neonates with initial abnormal aEEG profiles exhibited increased RV contraction after NICU discharge. Future studies should explore long-term cardiovascular follow-up of neonates with HIE, beyond the perinatal period.

Impact: What is the key message of your article? Cardiac performance in hypoxic ischemic encephalopathy is linked to adverse outcomes. Survivors with an abnormal aEEG at admission showed increased right ventricular contractility at follow-up, possibly related to an adverse adaptation to the initial insult. What does it add to the existing literature? This study offers insights into long-term cardiovascular outcomes in neonates with HIE, focusing on the link between initial aEEG abnormalities and later RV function. What is the impact? The findings underscore the importance of early cardiovascular assessments and monitoring in neonates undergoing TH for HIE, potentially guiding future follow-up protocols.

Impact: We identified cord blood gentamicin concentrations that were higher than anticipated, and above clinical targets for immediate gentamicin re-dosing after birth. Incorporation of gentamicin levels at birth may aid in optimizing postnatal gentamicin dosing among infants exposed to intrapartum gentamicin.

Background: The aim of this research is to examine the relationship between adherence to different possible combinations of the 24-hour movement guidelines and academic engagement in adolescents.

Methods: The cross-sectional study involved 742 students (median = 15.00; interquartile range = 3.00), aged 12 to 17 years (422 girls; 56.9%). Physical activity, screen time, sleep duration, and academic engagement were measured using self-report measurements. A generalized additive mixed model and a generalized linear mixed model were used to examine the association between adherence to 24-hour movement guidelines and academic engagement. Age, sex, socioeconomic status, body mass index, and school were considered as covariates.

Results: Students who met all three guidelines showed the highest levels of academic engagement. Conversely, the lowest levels of academic engagement were observed in those who did not meet any of the guidelines. In addition, students' academic engagement was higher as more 24-hour movement guidelines were met.

Conclusion: Our results suggest the importance of jointly promoting 24-hour movement guidelines, as it appears to have greater benefits on adolescent academic outcomes.

Impact: Not meeting any of the three 24-hour movement guidelines was associated with lower academic engagement. Meeting all three 24-hour movement guidelines was related to higher academic engagement. Previous research has focused on the association between the three 24-hour movement guidelines and academic performance. However, the relationships of these behaviors on academic engagement have been little studied. The results of this study highlight the importance of promoting these three behaviors in adolescent academic outcomes.

Background: Variability in pediatric dosing of desmopressin (ddAVP) in AVP-deficiency (AVP-D) is well-documented but dosing recommendations are limited. This study evaluates and optimizes ddAVP dosing regimens in children with AVP-D using pharmacokinetic and pharmacodynamic (PK/PD) simulations.

Methods: Retrospective electronic health record review was done to identify children (<18 years) with AVP-D on ddAVP evaluated in the outpatient setting using ICD 9 and 10 codes. A previously developed PK/PD model from Michelet et al was used to simulate ddAVP concentrations and urine rates based on a child's age and ddAVP dose. The effects of demographic characteristics (age, weight, etc.) on dose and urine rate were investigated through simulations to optimize doses of ddAVP for children who were wet overnight.

Result: A total of 276 dosing records were identified among 53 children with AVP-D. Simulations indicated that in children under 5 years of age who were wet overnight, increasing the outpatient dose to 50 mcg was predicted to decrease urine rate to a pattern similar to those who remained dry.

Conclusion: An initial outpatient dose of at least 50 mcg for children between 1 and 5 years of age would improve efficacy of ddAVP.

Impact: 50 mcg is likely a safe initial outpatient dose of oral desmopressin tablet for young children 1-5 yrs of age with central Diabetes Insipidus/AVP-Deficiency. We confirmed that desmopressin doses vary greatly in children with central Diabetes Insipidus/AVP-deficiency. Real-world clinical data can be leveraged to improve medication dosing in rare diseases.

For more than 20 years there has been speculation about a future in which newborns are routinely screened at birth for genetic disorders using genome sequencing, but prospective large-scale studies assessing this vision have only recently begun. Genome sequencing may provide a means of expanding the scope of conditions included in newborn screening programs and improving the positive predictive value of traditional newborn screening. However, the use of genome sequencing for newborn screening has also raised concerns including acceptability, equity, and scalability. By reviewing the initial results of the GUARDIAN study and contrasting them with other pilot studies investigating the use of genome sequencing for large-scale newborn screening, we highlight how the lessons learned from these studies are shaping the future for the implementation of truly universal and equitable newborn genomic screening.

Impact: The pediatric subspecialty workforce is challenged by shortages and geographic maldistribution of subspecialists. We invited leaders in pediatrics to discuss how the field's vitality and survival can be secured. These leaders presented their own opinions and not the opinion of the society or organization that they are presenting. Early exposure of future trainees to pediatrics and advocacy for improved reimbursement structures, loan repayment, and funded programs for physician scientists will enhance the recruitment and retention of pediatric subspecialists to guarantee advancement of knowledge and the appropriate care of children with chronic and complex diseases.

Background: Procalcitonin-guided antimicrobial decision-making has been shown to be safe in adult intensive care settings. Most antimicrobial exposure in neonatal units is in culture-negative conditions. We hypothesise that Procalcitonin aids antimicrobial stewardship efforts in suspected Late-Onset Neonatal Sepsis.

Methods: Neonates were enrolled if they were aged over 72 h and were placed on antibiotics for a suspected infection. Procalcitonin levels were taken at set timepoints for the duration of antimicrobial exposure. Three subgroups were created: non-infectious episodes, blood culture-negative infectious episodes, and bloodstream infections.

Results: Eighty-five suspected infectious episodes were recruited across two tertiary neonatal and paediatric intensive care units. There was a significant difference between the median PCT in bloodstream infections (BSI) compared to non-infectious episodes (2.13 versus 0.26 µg/L, p < 0.001). A cut-off of 0.5 µg/L had sensitivity 92.9% and specificity 68% for bloodstream infections at 24 h. The difference between median PCT values at 24 h was significant (0.27 vs 7.08; p < 0.001) for feed intolerance vs. NEC Grade IIIa-IIIb subgroups.

Conclusion: Procalcitonin levels taken 24 h following evaluation for late-onset neonatal infection are useful in out ruling BSI or severe Necrotising Enterocolitis. Up to 30% of antimicrobial exposure could be avoided with the use of Procalcitonin levels in low-risk neonates.

Impact: This study demonstrates the utility of serial Procalcitonin measurements in antimicrobial stewardship efforts in the Neonatal Unit. Procalcitonin can be used to aid in antimicrobial decision making in suspected Late-Onset neonatal infection. Procalcitonin testing at twenty-four hours in episodes of Gastrointestinal deterioration can out rule Bells Grade III Necrotising Enterocolitis.