Journal of Pediatrics最新文献

Objectives: To determine incidence and risk factors for hypertension in childhood nephrotic syndrome.

Study design: Using data from the Insight into Nephrotic Syndrome (INSIGHT) study, a prospective observational childhood nephrotic syndrome cohort from Toronto, Canada, we evaluated hypertension incidence and time-to-hypertension overall and stratified by 1) steroid-resistance or steroid-sensitivity, and 2) frequently-relapsing, steroid dependent, or infrequently-relapsing. Hypertension was defined as stage 1-2 hypertensive blood pressure on two consecutive visits or anti-hypertensive medication initiation.

Results: We included 748 children with nephrotic syndrome from 1996 to 2023. Median (quartile 1-3 [Q1-3]) age at diagnosis was 4 (2.8-6) years, 473 (63%) children were male, and 240 (32%) were of South Asian ethnicity. Forty (5%) children were steroid-resistant, 177 (24%) steroid-dependent, 113 (15%) frequently-relapsing, and 418 (56%) infrequently-relapsing. Median follow-up was 5.2 years (Q1-3 3.0-9.3). During follow-up, 393 (53%) children developed hypertension or were initiated on an anti-hypertensive medication (incidence rate 8.2 per 100 person-years, 95%CI 7.4-9.1). Hypertension was more common among children steroid-resistance than steroid-sensitivity (70% vs. 52%; adjusted HR 1.47, 95%CI 1.00-2.17). Hypertension was also more common in children who were steroid-dependent (67%; adjusted HR 1.81, 95%CI 1.43-2.30) and frequently-relapsing (63%; adjusted HR 1.64, 95%CI 1.23-2.18), than infrequently-relapsing (42%). Among steroid-sensitive patients, higher BMI Z-score and academic center were also significant hypertension risk factors.

Conclusions: Half of children with nephrotic syndrome develop hypertension. Children who are steroid-resistant, steroid-dependent, frequently-relapsing or have obesity are at greatest risk. Close blood pressure surveillance is justified to identify and treat hypertension.

Objective: To evaluate the accuracy of various point-of-care device methodologies for measuring blood glucose concentrations in babies at risk of neonatal hypoglycemia.

Study design: This systematic review and meta-analysis included studies from Ovid MEDLINE, Ovid Embase, and Web of Science up to May 20, 2024. Studies comparing point-of-care testing methods for neonatal blood glucose to a standard laboratory method were included, excluding those on continuous glucose monitoring or conducted before 1990. Two researchers independently assessed inclusion and evaluated risk of bias using QUADAS-2. Sensitivity and specificity were calculated using contingency tables, and diagnostic accuracy was analyzed using hierarchical random-effects modelling. Studies with insufficient data were summarized by estimation direction.

Results: Seventy-one studies were included. The quantitative analysis (n = 31) evaluated glucose oxidase (GO) + photometry (n = 8), glucose-1-dehydrogenase (GDH) + photometry (n = 6), GO + electrochemistry (n = 13), GDH + electrochemistry (n = 12), and hexokinase (HK) + electrochemistry (n = 2). All methods showed high specificity (≥93%), with GO + electrochemistry, GDH + electrochemistry, and HK + electrochemistry showing superior sensitivity. The SROC curve confirmed HK + electrochemistry as the most accurate.

Conclusion: Certain point-of-care device methodologies demonstrate greater accuracy in measuring neonatal blood glucose concentrations. Of the methods evaluated, HK + electrochemistry proved to be the most reliable. However, the limited number of studies using this method suggests the need for further research to confirm these findings across diverse settings and populations.

Objective: To explore perceptions, concerns, and enthusiasm from a diverse group of parents regarding early childhood research that involves home monitoring technologies for collecting environmental exposure data.

Study design: A diverse group of new and expecting parents participated in semi-structured interviews. A single interviewer conducted all sessions and introduced a hypothetical longitudinal early childhood research study, which included novel home monitoring approaches: 1) wearable devices, 2) audio monitoring, and 3) environmental sampling. Interviews were audio-recorded, transcribed, and coded. Qualitative description guided the study, and a constant comparative approach was used to identify themes from transcripts.

Results: Twenty-four interviews were completed. Emerging themes included 1) Ready and Willing to Participate; 2) Helping Others, Helping Ourselves: Motivation for Participation; 3) Trust and Transparency: Understanding the "What?" and the "Why?"; 4) Data Privacy and Security: "What If It Gets into the Wrong Hands?"; 5) It's a Lot to Juggle: Logistical Realities. Perceptions were similar across racial, ethnic, and socioeconomic groups. Perceptions were positive, and participants desired additional information about study feasibility and purpose. Many had concerns related to wearable device safety and data privacy; a trusting relationship with the research team was a priority.

Conclusion: Participants had positive sentiments regarding longitudinal observational studies involving pregnancy and infancy yet expressed concerns about safety, privacy, feasibility, and transparency. These findings can inform future early childhood research study design to ensure protocols are transparent, inclusive, and appealing to parents.