Pediatric Investigation最新文献

Importance: There is a lack of reliable early diagnostic criteria for autism spectrum disorder (ASD), despite earlier diagnosis leading to better outcomes.

Objective: To evaluate the association of aberrant auditory processing (AAP) as a potential early marker of ASD risk in children under 2 years old.

Methods: A systematic review of studies published between 1985 and September 2024 was conducted by searching PubMed and Web of Science.

Results: The review encompassed 18 studies with 140 231 participants, and a majority (76%) of these studies found evidence that early neurophysiological changes in auditory processing are associated with later ASD risk. Specifically, prolonged auditory brainstem response (ABR) latency, reduced social stimuli selectivity, and poorer auditory brain connectivity were correlated with ASD status in later childhood. Notably, auditory habituation did not differ significantly with ASD risk. It's important to recognize that the evidence was somewhat limited by heterogeneity, small sample sizes, and inadequate reporting.

Interpretation: This review identified three early neurophysiological AAP markers associated with ASD risk: ABR latency, social stimuli selectivity, and auditory brain coherence. These markers show potential for aiding in earlier ASD risk assessment in young children, potentially leading to earlier interventions. However, to fully establish the association of these AAP markers with ASD as a reliable screening tool during early childhood, future research should focus on standardized experimental protocols and adequately powered prospective cohort studies.

We recently came across an outbreak of parvovirus B19 related acute myocarditis in preschool children in a specific region in northern Greece. The children exhibited serious morbidity and mortality. All children had very poor left ventricular ejection fraction and required inotropic intensive care unit support.

Importance: Acute kidney injury (AKI) is common in hospitalized children which could rapidly progress into chronic kidney disease if not timely diagnosed. Prognostic prediction models for AKI were established to identify AKI early and improve children's prognosis.

Objective: To appraise prognostic prediction models for pediatric AKI.

Methods: Four English and four Chinese databases were systematically searched from January 1, 2010, to June 6, 2022. Articles describing prognostic prediction models for pediatric AKI were included. The data extraction was based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The risk of bias (ROB) was assessed according to the Prediction model Risk of Bias Assessment Tool guideline. The quantitative synthesis of the models was not performed due to the lack of methods regarding the meta-analysis of prediction models.

Results: Eight studies with 16 models were included. There were significant deficiencies in reporting and all models were considered at high ROB. The area under the receiver operating characteristic curve to predict AKI ranged from 0.69 to 0.95. However, only about one-third of models have completed internal or external validation. The calibration was provided only in four models. Three models allowed easy bedside calculation or electronic automation, and two models were evaluated for their impacts on clinical practice.

Interpretation: Besides the modeling algorithm, the challenges for developing prediction models for pediatric AKI reflected by the reporting deficiencies included ways of handling baseline serum creatinine and age-dependent blood biochemical indexes. Moreover, few prediction models for pediatric AKI were performed for external validation, let alone the transformation in clinical practice. Further investigation should focus on the combination of prediction models and electronic automatic alerts.

Importance: Pregnant women have a higher risk of severe illness or complications due to a severe acute respiratory syndrome coronavirus 2 infection. To reduce these risks, pregnant women are advised to coronavirus disease 2019 (COVID-19) vaccination. Continued monitoring of the safety of maternal COVID-19 vaccination remains important.

Objective: To evaluate the association between maternal COVID-19 vaccination and neonatal health.

Methods: Data from the Dutch Pregnancy Drug Register were used. In this prospective cohort study, pregnant women self-reported COVID-19 vaccination and neonatal health outcomes. We included women with a due date between January 15, 2021, and May 15, 2022, and a singleton live birth after at least 24 weeks gestation. Using log-binomial regression analysis we studied the association between COVID-19 vaccination during pregnancy and the health outcomes; small for gestational age (SGA), large for gestational age (LGA), and neonatal health problems. We corrected for potential confounders using inverse probability of treatment weighting.

Results: In total, 3655 participants were included (92.1% COVID-19 vaccinated during pregnancy). Of all participants, 8.9% reported SGA, 11.1% reported LGA, and 16.4% reported neonatal health problems. Maternal COVID-19 vaccination was not statistically significantly associated with SGA (adjusted prevalence ratio [aPR]: 0.90; 95% confidence interval [CI]: 0.59-1.36), LGA (aPR: 1.07; 95% CI: 0.70-1.63), or neonatal health problems (aPR: 0.84; 95% CI: 0.63-1.11).

Interpretation: This study indicates that COVID-19 vaccination during pregnancy is not associated with self-reported adverse neonatal health outcomes. These findings contribute to the growing body of evidence on the safety of COVID-19 vaccination during pregnancy.

Previous literature has well-established genetic factors as being associated with neuroblastoma (NB). About 1%-2% of NB cases are familial, with 85% of these cases predisposed to mutations in the PHOX2B and ALK genes. The genetic basis of sporadic NB has been studied through genome-wide association studies and next-generation sequencing approaches. Particularly, germline variants, as well as copy number variations, confer increased risks of NB, often with effect estimates ≥1.5, underscoring the strong genetic contributions to NB. However, the strength of the association varied in non-genetic factors. Some risk factors, such as birth defects, maternal illicit drug use, and early infections, had relatively stronger associations (effect estimates ≥1.5 or ≤0.67), while some other factors remain inconclusive. This suggests that certain non-genetic factors may play a more prominent role in NB risk, while further research is needed to clarify the impact of others. We synthesized and critically evaluated existing literature on the risk factors of NB to provide an overview, analyze the current state of knowledge, and outline a research path to address the relative contributions of genetic and non-genetic factors in NB. Future epidemiologic studies should incorporate novel methods for measuring genetic and non-genetic factors to comprehensively assess the full extent of factors contributing to NB. Furthermore, the utilization of dried blood spots holds promise to overcome technical and recruitment challenges for future studies. These strategies will contribute to a more holistic understanding of NB etiology and potentially lead to improved prevention strategies.

We evaluated the integration of the Rapid Interactive screening Test for Autism in Toddlers (RITA-T) model in a community, comparing autism spectrum disorder (ASD) toddlers' demographic and socioeconomic characteristics. Of 394 ASD toddlers, 323 were screened with RITA-T. Those screened were from more deprived areas, traveled farther and were diagnosed earlier. The model improved the diagnosis of ASD in underserved areas.

Importance: Objective measures of lung function are critical for assessing respiratory outcomes of prematurity. Among extremely low gestational age neonates (ELGANs) (< 29 weeks gestational age), high rates of neurodevelopmental impairment may interfere with lung function testing. Impulse oscillometry (IOS) is a noninvasive test of respiratory system mechanics not requiring forced expiration.

Objective: To describe a multicenter study design for respiratory follow-up testing in a cohort with a high rate of extreme prematurity.

Methods: School-age children enrolled in two prior trials of ELGANs and term controls were assessed by IOS at five centers. Groups consisted of children with prematurity with a high incidence of bronchopulmonary dysplasia, children with prematurity with no or minimal lung disease, and healthy term children. A rigorous centralized review process reviewed IOS studies for technical acceptability. Approach to design and implementation, rates of feasibility and success, and characteristics of participants are described.

Results: A total of 243 children were recruited, of whom 239 (98%) attempted oscillometry. There were high rates of technical acceptability across all three cohorts (85%-90% of attempted tests), and across all five centers (80%-94% of attempted tests). Respiratory and neuromotor clinical factors associated with testing failure included a higher number of days on ventilation during neonatal intensive care, a history of intraventricular hemorrhage grade 3 or 4, and gross motor functional impairment.

Interpretation: We report high rates of feasibility and success of oscillometry in a large multicenter ELGAN population, in whom neurological and developmental comorbidities likely play a confounding role.

Importance: Understanding the significance of motor skills in promoting physical fitness (PF) can offer valuable insights for devising comprehensive intervention and clinical rehabilitation programs for children with global developmental delay (GDD). However, it remains unclear whether fundamental motor skills (FMS) can improve the PF of children with GDD.

Objective: To investigate the correlation between FMS and PF in children with GDD.

Methods: A total of 180 children with GDD and 180 typically developing (TD) children aged 3-5 years were selected. All participants completed the Gesell Developmental Schedule, FMS, and PF tests at Beijing Children's Hospital between September 2022 and August 2023. Partial correlation and regression analyses were performed to examine the relationship between FMS and PF.

Results: Children with GDD had significantly lower FMS and PF scores compared to TD children (P < 0.05). No significant differences were found between males and females with GDD in FMS and PF score (P > 0.05). A more severe developmental delay was associated with lower FMS and PF scores. The correlation coefficients between individual FMS items and individual PF items, as well as the total PF score, ranged from 0.20 to 0.56. Regression analysis indicated that manual dexterity (β = 0.241, P = 0.029) and body balance (β = 0.399, P = 0.001) significantly predicted the total PF score.

Interpretation: In children with GDD, both FMS and PF are underdeveloped. Focusing on motor skills development is vital for promoting their PF.

Importance: Umbilical venous catheterization (UVC) is a common procedure for critically ill newborn infants. The insertion depth was estimated before the procedure using various formulae.

Objective: To compare the accuracy of five published formulae based on birth weight (BW).

Methods: This is a secondary retrospective analysis using data collected in a previous study, in which the actual final insertion depth of UVC was recorded. Predicted insertion depths were calculated by five published formulae based on BW. Then the actual depth and predicted depth were compared. Accurate position was defined as predicted depth being within ± 10% of actual depth. The accuracy rate calculated as "(accurately positioned UVCs/ all UVCs) × 100%" and the ratio of difference calculated as "(|predicted depth - actual depth|/ actual depth)" were compared among five formulae.

Results: Totally 1298 were enrolled, with gestational age 29.8 ± 2.3 weeks and BW 1215 ± 273 g. The accuracy rates were: Tambasco formula (67.2%), Shukla formula (65.0%), JSS formula (64.4%), BW formula (48.9%), and revised Shukla formula (26.9%). Tambasco formula had the highest accuracy rate in newborns with BW ≥ 1000 g. JSS formula had the highest accuracy rate in newborns with BW<1000 g.

Interpretation: It is suggested to use the Tambasco formula for estimating the UVC insertion depth for newborns, especially for those with BW ≥ 1000 g, and to apply the JSS formula for newborns with BW < 1000 g. There is no universal formula for achieving 100% accurate positioning.