Clinical and Experimental Pediatrics最新文献

Background: Bronchopulmonary dysplasia (BPD) is the most prevalent chronic lung disease in very preterm infants; however, conventional classifications have limited ability to predict severity before 36 weeks' postmenstrual age (PMA). A new Japanese classification, based on small for gestational age (SGA), bubbly/cystic chest radiographic findings, and chorioamnionitis (CAM), was proposed to enable earlier risk stratification. However, its validation in homogeneous cohorts is warranted.

Purpose: This study aimed to examine the association between this new Japanese classification and severe BPD development at 36 weeks' PMA in a secondary analysis of a randomized controlled trial (RCT).

Methods: A retrospective secondary analysis of a multicenter, double-blind RCT of inhaled corticosteroids in 12 tertiary neonatal intensive care units in Japan (2006-2009) was performed. Infants with a birth weight (BW)<1,000 g and requiring mechanical ventilation were enrolled. Of those 211 infants, 194 survivors were analyzed. Severe BPD was defined by National Institute of Child Health and Human Development criteria as requiring supplemental oxygen (fraction of inspired O2 >0.30) or positive pressure ventilation at 36 weeks' PMA. Logistic regression analyses were adjusted for gestational age, BW, sex, Apgar score, maternal steroid use, respiratory distress syndrome, and patent ductus arteriosus.

Results: Among the 194 infants, 25 were SGA, 45 had bubbly/cystic findings, and 86 had CAM. Severe BPD occurred in 80 infants. A multivariate analysis identified SGA (adjusted odds ratio [aOR], 3.32; 95% confidence interval [CI], 1.16-9.48; P=0.032) and bubbly/cystic findings (aOR, 10.88; 95% CI, 4.43-26.72; P<0.01) as independent risk factors. Compared with type II (non-CAM, no bubbly/cystic findings), type I (bubbly/cystic only: aOR, 6.21; 95% CI, 1.93-14.36) and type III (CAM plus bubbly/cystic: aOR, 15.32; 95% CI, 2.48-46.32) were significantly associated with severe BPD.

Conclusion: The new Japanese classification demonstrated that SGA and bubbly/cystic findings at day 28 independently predicted severe BPD. Early stratification using this classification may facilitate the early identification of high-risk infants for targeted interventions.

Background: Food allergies affect 4%-6% of the pediatric population and are often present within the first 2 years of life. Cord blood cells and cytokines in high-risk infants can predict allergic problems; however, their predictive value remains unclear.

Purpose: This study aimed to determine whether a cow's milk allergy in infants can be predicted using a basophil activation test (BAT) of cord blood samples by stimulating basophils with milk protein antigens (cow's milk and casein).

Methods: We collected cord blood during the birth of 30 mother-child pairs and immediately analyzed BAT stimulated with milk protein antigens. One year later, we compared the results of those infants who developed an allergy to those who did not.

Results: We found that infants with a casein-BAT value ≥2.6 were 33.2 times more likely than those with a casein- BAT value <2.6 to develop food allergy symptoms within the first year of life (P=0.03).

Conclusion: High casein-BAT values in cord blood may predict the development of food allergies during the first year of life. Although no association with cow's milk sensitivity has been found, casein sensitivity may indicate food allergy risk. However, further studies are required to confirm this association.

Background: The impact of arterial blood pressure on cerebral oxygenation during immediate postnatal transition is poorly understood.

Purpose: Here we investigated the association between arterial blood pressure (BP), cerebral tissue oxygenation index (cTOI), and cerebral fractional tissue oxygen extraction (cFTOE) during the immediate postnatal transition in preterm and full-term neonates.

Methods: This prospective observational study included preterm and term neonates who did versus did not require respiratory support. Oscillometric BP was measured at 5, 10, and 15 minutes after birth. cTOI was continuously monitored using near-infrared spectroscopy, while arterial oxygen saturation (SpO2) was recorded using pulse oximetry. cFTOE was calculated from cTOI and SpO. cTOI and cFTOE values were correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at all time points. Correlation and mixed-model analyses were then performed.

Results: A total of 102 neonates were enrolled: 51 preterm (33 with, 18 without respiratory support) and 51 term (14 with, 37 without respiratory support). In preterm neonates requiring respiratory support, cTOI was positively correlated with DABP at all time points and with MABP at 15 minutes. cFTOE was negatively correlated with MABP and DABP throughout the experiment and with SABP at 5 minutes. No significant correlations were observedamong the other groups. A mixed-model analysis showed that MABP and DABP were significantly associated with cFTOE but not cTOI independent of gestational age or respiratory support.

Conclusion: Among preterm neonates requiring respiratory support, cTOI and cFTOE were associated with arterial BP during the immediate neonatal transition. Only cFTOE showed a slight association with BP among stable preterm and full-term neonates. These findings suggest impaired cerebral autoregulation in compromised preterm infants during the immediate postnatal transition.

Background: Patients with coarctation of the aorta (CoA) and an interrupted aortic arch (IAA) may present with small mitral valves (MVs) and a reduced left ventricular (LV) volume. Biventricular repair (BVR) in these patients is dependent on adequate size of the left cardiac structures.

Purpose: This study evaluated the impact of the hemodynamic characteristics of atrial septal defects (ASDs) on MV growth following surgical repair.

Methods: We retrospectively reviewed the data of patients diagnosed with CoA or IAA between 2007 and 2024. The z score for MV size measured 6 months postoperatively (Z2) was compared with the preoperative MV size (Z1). The factors associated with MV growth were also studied.

Results: A total of 161 patients with CoA or IAA were included. Transthoracic echocardiography was used to assess the MV and LV dimensions preoperatively and 6 months postoperatively. Of the cohort, 155 (96.3%) underwent initial BVR and 6 underwent single-ventricle palliation. MV z scores significantly increased following BVR (mean change: +0.45±1.35; P<0.001) but decreased after single-ventricle repair (-0.56±0.49, P=0.04). Multivariate analysis identified the initial MV z score and ASD pressure gradient as independent predictors of MV growth (R²=0.39).

Conclusion: Annular growth of the MV was not observed in patients who underwent single-ventricle palliation. In contrast, among patients who achieved BVR, those with a small preoperative MV annulus and low ASD pressure gradient demonstrated subsequent catch-up MV growth, suggesting that adequate left-sided preload isessential for MV development.

Background: Febrile neutropenia (FN) remains a leading cause of morbidity and mortality in pediatric patients with high-risk hematologic disorders, particularly in low- and middle-income countries (LMICs), where antimicrobial resistance limits treatment options. Granulocyte transfusion (GT) is considered an adjunctive therapy; however, pediatric data from LMICs are limited.

Purpose: This study evaluates the effectiveness, timing, and safety of GT in a real-world LMIC setting.

Methods: This 15-year retrospective cohort study included pediatric patients (≤18 years) with severe neutropenic infections treated at a national tertiary referral center in Thailand in 2009-2023. The patients received GT plus antimicrobial therapy or antimicrobial therapy alone. The primary outcome measure was 30-day survival. The analyses included multivariate logistic regression, Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW).

Results: Among the 54 patients (26 GT recipients; 28 controls), GT was associated with improved 30-day survival in the full cohort (odds ratio [OR], 0.105; 95% confidence interval [CI], 0.016-0.700; P=0.020). IPTW confirmed this association (OR, 0.099; P=0.001), with consistent results in the PSM analysis (OR, 0.157; P=0.028). In the high-risk hematologic condition subgroup (n=48), GT was associated with increased survival (95.2% vs. 61.9%; hazard ratio [HR], 0.105; P=0.034). GT also accelerated the resolution of fever (HR, 2.24; P=0.028), FN recovery (HR, 2.35; P=0.017), and absolute neutrophil count recovery (HR, 2.10; P=0.047). No serious transfusion-related adverse events were observed.

Conclusion: GT was associated with improved survival and faster clinical recovery in pediatric patients with FN. These real-world LMIC data support its use as a feasible adjunctive therapy and warrant prospective validation.

Background: Acute necrotizing encephalopathy (ANE) is a rare but devastating neurological disorder in children that is typically triggered by viral infections such as influenza, sudden acute respiratory syndrome coronavirus 2, and human herpesvirus-6. ANE is characterized by cytokine storm and associated with high mortality; however, optimal immunomodulatory strategies remain undefined.

Purpose: To evaluate the effectiveness of multiple immunomodulatory strategies, including high-dose methylprednisolone (MP), plasma exchange (PLEX), and tocilizumab, at reducing short-term mortality among pediatric patients with ANE stratified by disease severity using the ANE severity score (ANE-SS).

Methods: We retrospectively reviewed 65 pediatric patients (median age, 4.8 years; interquartile range, 2.8-7.7 years) diagnosed with ANE at Beijing Children's Hospital from 2016 to 2024. Patients were stratified by ANE-SS at admission into low- to medium-risk (ANE-SS<5) and high-risk (ANE-SS≥5) groups. Immunomodulatory treatments included different doses of MP, intravenous immunoglobulin, PLEX, and tocilizumab. The primary outcome was the 28-day postdischarge mortality. Multivariate logistic regression was used to identify the treatment strategies that were independently associated with improved survival.

Results: The overall 28-day postdischarge mortality rate was 45.9%, significantly higher in patients with ANE-SS ≥5 (65.7%) than in those with ANE-SS<5 (16.7%; P<0.001). A notable decline in mortality has been observed since 2022, coinciding with the increased use of high-dose MP (20 and 30 mg/kg/day) and tocilizumab. The annual mortality rate will drop to 38.9% in 2022, 36.8% in 2023, and 16.7% in 2024. In low- to medium-risk patients (ANE-SS<5), both 20-mg/kg/day and 30-mg/kg/day MP were associated with improved outcomes. In high-risk patients (ANE-SS≥5), the combination of 30-mg/kg/day MP and tocilizumab provided the greatest survival benefit. Multivariable logistic regression analysis identified that this combined therapy was independently associated with reduced mortality (odds ratio, 0.04; 95% confidence interval, 0.01-0.18; P<0.001). No significant survival benefit was observed following PLEX treatment.

Conclusion: In low- to moderate-risk patients, the 20- and 30-mg/kg/day MP regimens were effective. In high-risk patients with ANE, high-dose MP (30 mg/kg/day), particularly when combined with tocilizumab, may improve survival and possibly long-term neurological recovery. These findings support the use of a severity-based immunotherapy strategy for pediatric patients with ANE.

Pneumococcal disease remains the leading cause of morbidity in young children worldwide. Recent advances have expanded pneumococcal conjugate vaccines (PCVs) beyond 13-valent (PCV13) to 15-valent (PCV15) and 20- valent (PCV20) vaccines, which add 2 and 7 serotypes, respectively, thereby broadening their potential protective effects against invasive pneumococcal disease (IPD). Although policies vary among countries, Korea incorporated PCV15 and PCV20 into its National Immunization Program for children in April 2024 and October 2025, respectively, an implementation that is considered within the context of global epidemiology and policy trends. This review discusses evidence of the immunogenicity and safety of PCV15 and PCV20 from clinical trials and early postlicensure data, examines the serotype distribution and IPD burden in Korea alongside data from other regions, and summarizes vaccination recommendations for healthy and high-risk pediatric populations, including considerations for catch-up, interchangeability, and their coadministration. By integrating national updates and global evidence, this review aims to support clinicians and policymakers worldwide optimizing pneumococcal vaccination strategies for children.

The ingestion of foreign bodies and caustic substances represents a significant clinical concern in pediatric populations, particularly among children aged 1-5 years. These events can result in a wide spectrum of complications ranging from acute, life-threatening emergencies to delayed sequelae with long-term morbidities. The severity and clinical course are influenced by multiple factors, including ingested material's nature, size, shape, and chemical composition, as well as its anatomical location, particularly when esophageal impaction occurs. High-risk foreign bodies- such as button batteries, high-powered magnets, sharp objects, superabsorbent polymers, and items containing toxic substances-pose an elevated risk of rapid tissue injury or perforation. Similarly, the ingestion of caustic agents, whether acidic or alkaline, carries the potential for extensive mucosal damage, with the degree of injury dictated by the pH, volume ingested, and inherent toxicity. Clinical management requires a highly individualized, case-by-case approach guided by the clinical presentation, imaging findings, and endoscopic evaluation findings. Endoscopy plays a pivotal role in the diagnostic assessment of mucosal injury and is a therapeutic modality for foreign body retrieval. Timely endoscopic interventions are strongly associated with improved outcomes and reduced complication rates. A high index of clinical suspicion remains critical to ensuring early diagnosis, prompt intervention, and the prevention of both acute and long-term complications, including strictures, perforations, and impaired quality of life. Comprehensive, multidisciplinary management is essential for optimizing patient outcomes in these potentially complex clinical scenarios.

Background: Associations have been suggested between prenatal exposure and allergic diseases in children as well as between respiratory allergies and maternal sleep disorders during pregnancy.

Purpose: This study aimed to examine the association between maternal sleep disorders during pregnancy and allergic diseases, including respiratory, skin, and ocular allergies, in their children.

Methods: This study was based on the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Sleep disorders during pregnancy were defined as an Athens Insomnia Scale score of ≥6. Allergic diseases in children up to 5 years of age were assessed by maternal self-report on "bronchial asthma," "atopic dermatitis," "food allergy," and "allergic conjunctivitis/allergic rhinitis/hay fever." Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox proportional hazards model.

Results: A total of 11,123 mother-child pairs were included. The mean gestational age at registration was 19.6±7.6 weeks. During pregnancy, 4,115 women (37.0%) experienced sleep disorders. Additionally, 53.7% of the participants had a history of parity, 8.8% worked night shifts, and 0.4% used sleep medications. In the crude models, maternal sleep disorders during pregnancy were associated with all examined allergic diseases in children. After the adjustment for all confounders, the associations remained significant for atopic dermatitis and allergic conjunctivitis/allergic rhinitis/hay fever (HR [95% CI], 1.09 [0.97-1.23] for bronchial asthma, 1.17 [1.05-1.31] for atopic dermatitis, 1.11 [0.98-1.26] for food allergy, and 1.25 [1.13-1.39] for allergic conjunctivitis/allergic rhinitis/hay fever).

Conclusion: Maternal sleep disorders during pregnancy were associated with atopic dermatitis as well as allergic conjunctivitis/allergic rhinitis/hay fever in children.