Journal of Pediatrics最新文献

Objective: To assess variations in children's cognitive and language test scores according to observed dyadic maternal sensitivity and the child's gestational age, after adjustment for known confounders.

Study design: Systematic review and a one-stage individual participant data (IPD) meta-analysis of harmonized data from 7 birth cohorts across 5 countries (N=2,560) using mixed effects linear regression. Maternal sensitivity and child cognition and language test scores were z-standardized relative to contemporary cohort-specific term-born controls. Models were adjusted for child sex, multiple birth, small for gestational age, age at outcome assessment, mother's education, mother's age at the child's birth, single mother status, and additionally child neurodevelopmental impairment.

Results: Maternal sensitivity was associated with subsequently assessed cognition (0.20 [95% CI 0.14, 0.26], P<.001) and language (0.15 [0.08, 0.22], P<.001). A significant interaction between gestational age and sensitivity on cognition (-0.01 [-0.02, -0.01], p=.001) was observed; the association between sensitive parenting and later cognition was stronger among children born at younger gestational ages. Sensitivity analyses adjusting for children's neurodevelopment impairments produced similar findings.

Conclusion: High maternal sensitivity is a potential protective factor for cognitive and language functioning for children born preterm, especially among those born at lower gestational ages.

Objective: To assess lung function and bronchodilator reversibility via the impulse oscillometry system (IOS) in 3-6-year-olds with bronchopulmonary dysplasia (BPD), a population historically difficult to evaluate via spirometry.

Study design: A retrospective review of IOS in 3-6-year-olds was conducted. Clinical data were abstracted from electronic medical records, including a modified Saint-George Respiratory Questionnaire (SGRQ) scored according to symptoms, activity, and impact.

Results: We analyzed 103 IOS reports in 73 patients (median age 4.1 years [IQR 3.5-5.0]); of these, 52.4% were acceptable and repeatable. At least one parameter was abnormal in 78% of reports, including elevated resistance with median Z-scores for R₇ (1.8 [IQR 0.9-2.8]) and R_7-20 (1.4 [IQR 0.8-2.2]) and decreased reactance with median AX (2.6 [IQR 0.8,3.3]), F_res (1.4 IQR [.6-2.4]) and X₇ (-2.4 IQR[-3.7,--1.4]). Median Z-scores for the cohort normalized after albuterol. Improved resistance and reactance were observed on clinic follow-up IOS in children treated with inhaled corticosteroid/long-acting-beta-agonists. The cohort had increased morbidity with total SGRQ score of 12.1 [IQR 7.6-25.6]; symptom score of 32.5 (IQR 17.2-46.8), activity score of 7.6 (IQR 0-29.8) and impact score of 7.4 (IQR 0-17.1).

Conclusions: IOS can be performed by half of preschool children with BPD and reveals abnormal lung function characterized by elevated airway resistance and decreased reactance that is bronchodilator responsive. IOS is a feasible technique to evaluate objectively the early, critical changes in respiratory health and response to medical therapy in a population where other methods are not available.

Objective: To estimate the association between chronic neurologic disorders (NDs) and severe COVID-19 among hospitalized children and youth, and assess how multimorbidity (ie, ≥2 chronic comorbidities) modifies this association.

Study design: We conducted a national surveillance study at 13 children's hospitals in Canada from April 2020-December 2022, via the Canadian Paediatric Surveillance Program and Canadian Immunization Monitoring Program, ACTive. Eligible cases were <17 years old and hospitalized for COVID-19. Chronic comorbidities were classified using the Medical Dictionary for Regulatory Activities. Severe COVID-19 included any case of intensive care unit admission, ventilatory/hemodynamic support, systemic complication, and/or death. Mixed-effects robust Poisson regression was conducted to estimate adjusted prevalence ratios (aPR) between NDs and severe COVID-19, with interaction terms accounting for multimorbidity.

Results: Among 3218 cases hospitalized for COVID-19, 601 (18.7%) had NDs. Most (n=476/601, 79.2%) cases with NDs had ≥2 chronic comorbidities. Severe COVID-19 was more common among cases with cerebral palsy (aPR 1.30, 95% CI 1.08-1.57), epilepsy (aPR 1.50, 95% CI 1.14-1.96), genetic disorders with neurologic abnormalities (aPR 1.41, 95% CI 1.18-1.67), and neuromuscular disorders (aPR 1.37, 95% CI 1.08-1.75). Compared with cases without comorbidities, there was a dose-response relationship among ND cases in which additional comorbidities modified associations with severe COVID-19 (eg, aPR 1.29 [95% CI 1.03-1.62] for cases with one comorbidity; aPR 2.86 [95% CI 2.11-3.87] for cases with ≥ 4 comorbidities).

Conclusions: Children and youth with NDs are disproportionately affected by severe COVID-19, and patients with multimorbidity were at greatest risk. Many cases with NDs remained unvaccinated against SARS-CoV-2 and may benefit from efforts to encourage vaccine uptake.

A 15-year retrospective cohort study of 53,830 children 6-59 months old in a Federally Qualified Health System identified 10 febrile seizures 7-14 days after measles vaccination (incidence rate 2.05 [95% CI 0.98, 3.77] per 100,000 person-days); all had concurrent illnesses and co-administered vaccines. To date, no child has developed epilepsy.

Objective: To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia (BPD) in neonatal intensive care units (NICUs) across Europe.

Study design: Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age (GA) <28 weeks.

Results: We received replies from 447/721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the GA is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmH₂O and start with an FiO₂ 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO₂ target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide (iNO) is not used. Treatment of patent ductus arteriosus (PDA) varies; half of NICUs pharmacologically treat PDA early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent.

Conclusion: This large survey shows considerable practice variation in preventing and treating evolving BPD across Europe, especially for interventions with limited evidence.