Lancet Child & Adolescent Health最新文献

英文中文

Diagnostic labels and clusters based on oxygen requirements in preterm infants with chronic lung disease: a data-driven exploratory cluster analysis in two independent cohorts 基于慢性肺部疾病早产儿需氧量的诊断标签和聚类：两个独立队列的数据驱动探索性聚类分析

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2025-12-15 DOI: 10.1016/S2352-4642(25)00314-1

Damian Alvarez-Paggi PhD , Anhar Ullah PhD , Gaston Ofman MD , Sadia Haider PhD , Florencia Nowogrodzki MD , Sara Fontanella PhD , Jacqui Marzec MSc , Jorge Digregorio MD , Guillermo Colantonio MD , Mariana Sorgetti MD , Mariangeles Quiros MD , Andrea Brum MD , Silvia Garcia MD , Cristina Osio MD , Santiago Lopez Garcia MD , Gonzalo Mariani MD MSc , Maria Fernanda Galletti MD MSc , Silvina Coviello MSc , Clarice R Weinberg PhD , Nestor Vain MD , Judith Voynow MD

Background

Diagnosis of bronchopulmonary dysplasia in very low birthweight infants is often only ascertained many weeks after birth. We aimed to investigate whether trajectories of the fractions of inspired oxygen (FiO₂) required to maintain O₂ saturation from birth reflect distinct clusters of preterm lung disease.

Methods

In this data-driven exploratory cluster analysis, we used latent class trajectory modelling to derive clusters of FiO₂ fluctuations in the first 30 days of life among neonates with a birthweight of less than 1250 g, across two multicentre, prospective cohorts: the Discovery Bronchopulmonary Dysplasia Program (D-BPD; enrolment July 30, 2013, to Jan 1, 2020; n=376) in Argentina and the Prematurity and Respiratory Outcomes Program (PROP; enrolment Aug 1, 2011, to Nov 31, 2013; n=835) in the USA, with the PROP cohort being used for external validation. Eligible participants, in both the present and original studies, included infants with birthweight of less than 1250 g in the D-BPD cohort, and infants enrolled in the PROP study born at 23–28 weeks of gestation by best obstetrical estimate. After unsupervised clustering of patients, we evaluated cluster performance against conventional bronchopulmonary dysplasia classification, using mortality as the primary outcome.

Findings

Of the 376 D-BPD infants, 190 (51%) were female (mean birthweight 968·1 g [SD 181·2]; mean gestational age 28·9 weeks [SD 2·3]) and 186 (49%) were male (mean birthweight 976·2 g [188·3]; mean gestational age 28·6 weeks [2·3]). Four clusters based on FiO₂ requirements were identified: persistently low requirement (PLR; 218 [58%] of 376), early high with subsequent improvement (EHRI; 60 [16%] of 376), late-onset high requirement (LOHR; 31 [8%] of 376), and persistently high requirement (PHR; 67 [18%] of 376). Mortality was more frequent in LOHR (six [19%] of 31) and PHR (ten [15%] of 67) clusters, with no deaths in PLR and one death in EHRI (one [2%] of 60; p<0·0001). Nine (53%) of 17 fatal cases occurred before 36 weeks' gestational age, precluding conventional bronchopulmonary dysplasia diagnosis; among infants who died later, most had severe bronchopulmonary dysplasia (six [67%] of nine). Results from the PROP cohort closely mirrored those of D-BPD, yielding the same number of clusters with similar trajectories and replicating patterns of mortality.

Interpretation

Current bronchopulmonary dysplasia definitions might not fully capture the trajectories of lung disease of preterm infants. Data-driven approaches offer opportunities to identify infants at high risk earlier and to implement more precise interventions.

Funding

US National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, and the UK MRC.

背景：极低出生体重儿的支气管肺发育不良的诊断通常在出生数周后才确定。我们的目的是研究从出生开始维持氧饱和度所需的吸入氧（FiO2）分数的轨迹是否反映了不同的早产儿肺部疾病。方法在这项数据驱动的探索性聚类分析中，我们使用潜在类别轨迹模型，在两个多中心前瞻性队列中，得出出生体重小于1250 g的新生儿出生后30天FiO2波动的聚类：阿根廷的发现支气管肺发育不良项目（D-BPD， 2013年7月30日至2020年1月1日，n=376）和早产和呼吸结局项目（PROP， 2011年8月1日至2013年11月31日）；n=835)，其中PROP队列用于外部验证。在目前和最初的研究中，符合条件的参与者包括D-BPD队列中出生体重小于1250 g的婴儿，以及PROP研究中根据最佳产科估计出生在妊娠23-28周的婴儿。在对患者进行无监督聚类后，我们以死亡率作为主要结局，评估了传统支气管肺发育不良分类的聚类表现。结果376例D-BPD患儿中，女性190例（51%）（平均出生体重968·1 g [SD 181·2]，平均胎龄28.9周[SD 2.3]），男性186例（49%）（平均出生体重976·2 g[188·3]，平均胎龄28.6周[2.3]）。根据FiO2要求确定了四组：持续低需要量（PLR， 376例中218例[58%]），早期高需要量并随后改善（EHRI， 376例中60例[16%]），晚发性高需要量（LOHR， 376例中31例[8%]）和持续高需要量（PHR， 376例中67例[18%]）。死亡率在LOHR（31例中有6例[19%]）和PHR（67例中有10例[15%]）聚集中更为常见，PLR中无死亡，EHRI中有1例死亡（60例中有1例[2%]；p< 0.0001）。17例死亡病例中有9例（53%）发生在孕36周之前，排除了常规的支气管肺发育不良诊断；在后来死亡的婴儿中，大多数患有严重的支气管肺发育不良（6 / 9[67%]）。来自PROP队列的结果与D-BPD的结果非常接近，产生了相同数量的具有相似轨迹和复制死亡率模式的集群。目前的支气管肺发育不良定义可能不能完全反映早产儿肺部疾病的发展轨迹。数据驱动的方法为及早发现高危婴儿和实施更精确的干预措施提供了机会。美国国家环境健康科学研究所、国家卫生研究院、卫生与公众服务部和英国医学研究委员会。

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引用次数: 0

Correction to Lancet Child Adolesc Health 2025; 9: 837–47 《柳叶刀儿童青少年健康2025》修订版；9: 837 - 47

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/S2352-4642(25)00381-5

引用次数: 0

The future of survey research with the world's sexual or gender minority youth 未来与世界性取向或性别少数青年的调查研究

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2025-11-14 DOI: 10.1016/S2352-4642(25)00315-3

Stephanie Spaid Miedema , Laura F Chiang , Kerry L D MacQuarrie , Tu Anh Hoang , K L Dunkle , Leanne Riley , Sophie West-Browne , Raphaëlle Rafin , Kyle Bernstein

引用次数: 0

Vascular and inflammatory diseases after COVID-19 infection and vaccination in children 儿童COVID-19感染和疫苗接种后的血管和炎症疾病

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/S2352-4642(25)00377-3

Alberto Donzelli

引用次数: 0

Muscle dysmorphia in adolescents and young adults 青少年和青年的肌肉畸形

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2025-12-02 DOI: 10.1016/S2352-4642(25)00283-4

Jason M Nagata MD , Jacqueline O Hur BA , Ken Murakami BA , Kyle T Ganson PhD , Jinbo He PhD , Stuart B Murray PhD , Jason M Lavender PhD

Body image concerns among adolescent boys and young men are increasingly recognised as societal ideals shift towards a lean, muscular physique. In severe cases, these pressures can lead to muscle dysmorphia, a specifier of body dysmorphic disorder marked by preoccupation with being too small or insufficiently muscular. Adolescents and young adults are developmentally vulnerable and might be at higher risk for a variety of eating-related and body image-related concerns, including muscle dysmorphia. This narrative Review synthesises current evidence on the epidemiology, assessment, and treatment of muscle dysmorphia in adolescents and young adults to guide clinicians. Although some treatment approaches show promise, outcome data in large, diverse, clinical adolescent samples remain scarce. Muscle dysmorphia-specific preventive strategies are few, although eating disorder prevention programmes show potential for reducing muscle dysmorphia symptoms. Future research should investigate pharmacotherapy and prevention programmes, validate assessment tools across populations, and examine cultural influences internationally. Advancing understanding of muscle dysmorphia will better equip clinicians to identify and address symptoms in adolescents and young adults.

随着社会理想向精瘦、肌肉发达的体格转变，青春期男孩和年轻男性对身体形象的担忧日益得到认可。在严重的情况下，这些压力可导致肌肉畸形，这是一种身体畸形障碍的具体说明，其特征是专注于太小或肌肉不足。青少年和年轻人在发育上是脆弱的，可能更容易出现各种与饮食和身体形象相关的问题，包括肌肉畸形。这篇叙述性综述综合了青少年和年轻人肌肉畸形的流行病学、评估和治疗方面的现有证据，以指导临床医生。尽管一些治疗方法显示出希望，但在大量、多样化的青少年临床样本中，结果数据仍然很少。虽然饮食失调预防方案显示出减少肌肉畸形症状的潜力，但针对肌肉畸形的预防策略很少。未来的研究应该调查药物治疗和预防方案，验证跨人群的评估工具，并检查国际文化影响。推进对肌肉畸形的理解将使临床医生更好地识别和解决青少年和年轻人的症状。

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引用次数: 0

Delayed puberty and early-onset type 2 diabetes risk: a nationwide cohort study of male adolescents in Israel 青春期延迟和早发性2型糖尿病风险：以色列男性青少年的一项全国性队列研究

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/S2352-4642(25)00333-5

Prof Orit Pinhas-Hamiel MD , Maya Simchoni MD , Estela Derazne MSc , Cole D Bendor MD , Avishai M Tsur MD , Adi Vinograd MD , Miri Lutski PhD , Inbar Zucker MD , Prof Vibha Singhal MD , Prof Hertzel C Gerstein MD , Prof Arnon Afek MD , Prof Amir Tirosh MD , Prof Gilad Twig MD

Background

Delayed puberty has been associated with adverse metabolic outcomes, yet longitudinal evidence on its relation to type 2 diabetes risk is scarce. We aimed to investigate the association between delayed puberty during adolescence and early-adult-onset type 2 diabetes in male adolescents.

Methods

This nationwide, population-based, retrospective cohort study included Israeli male adolescents aged 16–19 years who were examined before military recruitment during 1992–2015 and followed up until Dec 31, 2019. Exclusion criteria were diabetes at the baseline medical assessment, hypogonadotropic hypogonadism, missing height or weight data, and death before the establishment of the Israeli National Diabetes Registry (INDR) in 2012. Delayed puberty was diagnosed by board-certified paediatric endocrinologists, based on physical examinations and laboratory evaluations. By linking data to the INDR, diabetes was identified by: glycated haemoglobin concentrations of more than 6·5%, serum glucose concentrations of more than 200 mg/dL in two tests at least 1 month apart, or repeated purchases of glucose-lowering medications. Type 2 diabetes was classified according to medication records, which underwent quality assessment to ensure accuracy. Cox proportional hazards models were applied.

Findings

The study included 964 108 Israeli male adolescents (mean age at evaluation 17·3 years [SD 0·5]). Delayed puberty was diagnosed in 4307 males, whereas 959 801 did not have delayed puberty. During a cumulative follow-up of 15 242 068 person-years, type 2 diabetes was diagnosed in 111 (2·6%) individuals with delayed puberty (mean age at diagnosis 35·5 years [SD 5·2]) and 6259 (0·7%) individuals without delayed puberty (36·8 years [4·7]). The respective incidence rates of type 2 diabetes were 140·3 cases per 10⁵ person-years (95% CI 114·2–166·4) and 41·3 cases per 10⁵ person-years (40·3–42·3; p<0·0001); absolute difference 99·0 (72·9–125·1). After adjustment for age, year of study entry, education, cognitive performance, residential socioeconomic status, and country of birth, delayed puberty was associated with an increased risk of type 2 diabetes (hazard ratio [HR] 2·47 [95% CI 2·04–2·99], p<0·0001). Additional adjustment for baseline BMI attenuated but did not eliminate the association (HR 1·37 [1·13–1·66]; p=0·0015). The findings persisted across extensive sensitivity analyses.

Interpretation

Male adolescents with delayed puberty are at increased risk of developing type 2 diabetes in early adulthood, independent of BMI. Our findings suggest that delayed puberty is not a benign developmental variant, but might serve as an early marker of increased risk for later abnormal glucose metabolism.

Funding

Sheba Medical Center.

背景：青春期延迟与不良代谢结果相关，但其与2型糖尿病风险之间的纵向证据很少。我们的目的是调查青春期延迟与男性青少年早发型2型糖尿病之间的关系。方法：这项基于全国人群的回顾性队列研究纳入了1992-2015年征兵前16-19岁的以色列男性青少年，随访至2019年12月31日。排除标准为基线医学评估时的糖尿病、促性腺功能低下、身高或体重数据缺失以及2012年以色列国家糖尿病登记处（INDR）建立之前的死亡。青春期延迟是由委员会认证的儿科内分泌学家根据身体检查和实验室评估诊断的。通过将数据与INDR联系起来，通过以下方式确定糖尿病：糖化血红蛋白浓度超过6.5%，两次测试中血清葡萄糖浓度超过200 mg/dL，间隔至少1个月，或反复购买降糖药物。根据用药记录对2型糖尿病进行分类，并进行质量评估以确保准确性。采用Cox比例风险模型。结果：该研究包括964108名以色列男性青少年（评估时平均年龄17.3岁[SD 0.5]）。4307名男性被诊断为青春期延迟，而959801名男性没有青春期延迟。在15 242 068人年的累计随访中，有111例（2.6%）青春期延迟（诊断时平均年龄35.5岁[SD 5.2]）和6259例（0.7%）未青春期延迟（36.8岁[4.7]）被诊断为2型糖尿病。2型糖尿病的发病率分别为每105人年140·3例（95% CI为114·2 ~ 166·4）和41.3例（95% CI为40·3 ~ 42·3；p < 0.01）；绝对差值为99·0（72·9-125·1）。在调整了年龄、入学年份、教育程度、认知表现、居住社会经济地位和出生国家等因素后，青春期延迟与2型糖尿病风险增加相关（风险比[HR] 2.47 [95% CI 2.04 - 2·99],p< 0.0001）。对基线BMI的额外调整减弱了相关性，但没有消除相关性（HR 1.37 [1.13 - 1.66]; p= 0.0015）。这些发现在广泛的敏感性分析中仍然存在。青春期延迟的男性青少年在成年早期患2型糖尿病的风险增加，与BMI无关。我们的研究结果表明，青春期延迟不是一种良性的发育变异，但可能是后期糖代谢异常风险增加的早期标志。为示巴医疗中心提供资金

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引用次数: 0

Cybervictimisation as a marker of broader youth harm 网络受害是更广泛的青少年伤害的标志。

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2025-12-08 DOI: 10.1016/S2352-4642(25)00343-8

Tracy Vaillancourt

引用次数: 0

The virtue of honesty in medicine 医学上诚实的美德

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2025-11-10 DOI: 10.1016/S2352-4642(25)00246-9

Jay R Malone

引用次数: 0

Impact of high-dose vitamin D and calcium carbonate supplementation on bone density in adolescents living with HIV: a randomised, placebo-controlled trial 高剂量维生素D和碳酸钙补充对艾滋病毒感染青少年骨密度的影响：一项随机、安慰剂对照试验

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/S2352-4642(25)00301-3

Prof Rashida A Ferrand PhD , Nyasha V Dzavakwa MSc , Tsitsi Bandason MSc , Molly Chisenga MSc , Prof Suzanne Filteau PhD , Prof Katharina Kranzer PhD , Hildah Banda Mabuda Diploma , Grace Mchugh MD , Prof Hilda Mujuru MSc , Nicol Redzo MSc , Prof Sarah L Rowland-Jones DM , Prof Ulrich E Schaible Dr rer nat , Victoria Simms PhD , Jonathan C Y Tang PhD , Lackson Kasonka MMed , Prof Celia L Gregson FRCP

<div><h3>Background</h3><div>HIV has adverse impact on skeletal development in children despite antiretroviral therapy (ART). We investigated the effect of high-dose (20 000 IU) weekly vitamin D<sub>3</sub> and daily calcium carbonate (500 mg) supplementation for 48 weeks on bone density and muscle strength and power among peripubertal individuals (11–19 years) with perinatally acquired HIV.</div></div><div><h3>Methods</h3><div>We conducted an individually randomised, double-blind, placebo-controlled trial. Individuals taking ART for at least 6 months who had a defined caregiver, and knew their HIV status (in those aged >12 years) were recruited from HIV clinics in Harare, Zimbabwe and Lusaka, Zambia. The primary outcome was total body less-head bone mineral density (TBLH-BMD) Z score and secondary outcome was lumbar spine bone mineral apparent density (LS-BMAD) Z score (both measured by dual-energy x-ray absorptiometry). Linear regression was used to compare arms adjusting for country and baseline value of the measure. Pre-specified subgroup analyses by country, age-group, sex, pubertal stage, calcium intake, tenofovir disproxil fumarate use, and baseline vitamin D insufficiency (defined as 25[OH]D <75 nmol/L), and a post-hoc subgroup analysis by viral suppression, were performed. A Participant Advisory Board that included adolescents with HIV, their guardians, and health providers guided study conduct. The trial is registered with the Pan African Clinical Trials Registry, PACTR20200989766029.</div></div><div><h3>Findings</h3><div>Of 842 participants (median age 15 years [IQR 13–17], 448 [53%] female and 394 [47%] male) enrolled between Feb 4 to Nov 23, 2021, 639 (76%) were vitamin D insufficient. At 48 weeks, outcomes were available for 751 (89%) participants. There was no difference by arm in TBLH-BMD Z score (intervention <em>vs</em> control: mean –1·53 [SD 1·18] <em>vs</em> –1·56 [1·12], adjusted mean difference –0·04 [95% CI –0·01 to 0·09]) or in LS-BMAD Z score (intervention <em>vs</em> control: –0·64 [1·17] <em>vs</em> –0·71 [SD 1·16], adjusted mean difference –0·05 [95% CI –0·01 to 0·12]). However, among participants with vitamin D insufficiency at baseline, there was a significantly higher LS-BMAD Z score (adjusted mean difference 0·09 [95% CI 0·02 to 0·16], p<sub>interaction</sub>=0·025) in the intervention arm than in the control arm. The corresponding adjusted mean difference in TBLH-BMD Z score was 0·06 (0·00–0·11), p<sub>interaction</sub>=0·15. There was no statistical evidence of interaction in other subgroups. No drug-related severe adverse events were observed.</div></div><div><h3>Interpretation</h3><div>There was no difference in bone density between arms overall, but among those with vitamin D insufficiency the intervention improved bone density. High-dose vitamin D<sub>3</sub> and calcium supplementation, a safe and cheap intervention, during adolescence might promote bone accrual and mineralisation in those with vitami

背景：尽管抗逆转录病毒治疗（ART），艾滋病毒仍对儿童骨骼发育产生不利影响。我们研究了每周高剂量（20000 IU）维生素D3和每天补充碳酸钙（500 mg） 48周对围生期HIV感染者（11-19岁）骨密度和肌肉力量的影响。方法：我们进行了一项随机、双盲、安慰剂对照试验。从津巴布韦哈拉雷和赞比亚卢萨卡的艾滋病毒诊所招募了接受抗逆转录病毒治疗至少6个月、有明确照顾者并了解其艾滋病毒状况的个体（年龄在12岁）。主要指标为全身-头部骨矿物质密度（TBLH-BMD） Z评分，次要指标为腰椎骨矿物质表观密度（LS-BMAD） Z评分（均采用双能x线吸收仪测量）。采用线性回归比较国家调整臂和基线测量值。按照国家、年龄组、性别、青春期阶段、钙摄入量、富马酸替诺福韦双proxil的使用和基线维生素D不足（定义为25[OH]D & 75 nmol/L）进行预先指定的亚组分析，并通过病毒抑制进行临时亚组分析。由感染艾滋病毒的青少年、其监护人和保健提供者组成的参与者咨询委员会指导了研究的开展。该试验已在泛非临床试验登记处注册，注册号为PACTR20200989766029。研究结果：在2021年2月4日至11月23日期间，842名参与者（中位年龄为15岁[IQR 13-17]， 448名[53%]女性，394名[47%]男性）中，639名（76%）维生素D不足。48周时，751名（89%）参与者可获得结果。TBLH-BMD Z评分（干预组与对照组：平均- 1.53 [SD 1.18]对- 1.56[1.12]，校正平均差值- 0.04 [95% CI - 0.01至0.09]）或LS-BMAD Z评分（干预组与对照组：- 0.64[1.17]对- 0.71 [SD 1.16]，校正平均差值- 0.05 [95% CI - 0.01至0.12]）各组无差异。然而，在基线时维生素D不足的参与者中，干预组的LS-BMAD Z评分显著高于对照组（校正平均差为0.09 [95% CI 0.02至0.16]，p相互作用= 0.025）。相应的TBLH-BMD Z评分调整后的平均差异为0.06(0.00 - 0.11)，相互作用= 0.15。在其他亚组中没有统计学上的相互作用证据。未观察到与药物相关的严重不良事件。总体而言，两臂之间的骨密度没有差异，但在维生素D不足的人群中，干预改善了骨密度。在青春期大剂量补充维生素D3和钙是一种安全且廉价的干预措施，可能会促进维生素D不足患者的骨积累和矿化，从而增加骨量峰值。资助欧洲发展中国家临床试验伙伴关系。

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引用次数: 0

Investing in adolescent girls works: we can’t afford to stop 投资于青春期女孩是有效的：我们不能停止

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health

Pub Date : 2026-02-01 Epub Date: 2025-11-10 DOI: 10.1016/S2352-4642(25)00312-8

Lauren Rumble , Suzanne Petroni , Lucie Cluver , Chernor Bah , Fanta K Toure

引用次数: 0

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