Journal of Pediatrics最新文献

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Electrographic Seizures and Predictors of Epilepsy after Pediatric Arteriovenous Malformation Rupture 小儿动静脉畸形破裂后的电图癫痫发作和预测因素

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-28 DOI: 10.1016/j.jpeds.2024.114325

Julia S. Keenan BS , Dana B. Harrar MD, PhD , Claire Har MPH, BS , Caroline Conley DNP, CPNP-AC/PC , Katelyn Staso MS, CPNP-AC , Arnold J. Sansevere MD

Objectives

To assess clinical and electroencephalogram (EEG) predictors of epilepsy and to describe the percentage of electrographic seizures and development of epilepsy among patients with spontaneous intracerebral hemorrhage (ICH) due to arteriovenous malformation (AVM) rupture.

Study design

Retrospective review of patients admitted to the pediatric intensive care unit with ICH secondary to AVM rupture over 11 years. Clinical variables were collected by review of the electronic medical record. Seizures were described as acute symptomatic (7 days after AVM rupture), subacute (7-30 days after AVM rupture) and remote (greater than 30 days after AVM rupture). Outcome metrics included mortality, and the development of epilepsy post discharge. Descriptive statistics were used.

Results

Forty-three patients met inclusion criteria with a median age of 12.2 years (IQR 7.3-14.8) and 49% (21/43) were female. Sixteen percent (7/43) presented with a clinical seizure prior to EEG placement. EEG was performed in 62% (27/43) of patients; one had electrographic status epilepticus without clinical signs. Sixteen percent (7/43) of patients were diagnosed with epilepsy, with a median time to diagnosis of 1.34 years (IQR 0.55-2.07) after AVM rupture. One-year epilepsy-free survival was 84% (95% CI 70%-98%) and 2-year epilepsy-free survival was 79% (95% CI 63%-95%) Remote seizures were associated with epilepsy (P < .001), but acute symptomatic seizures were not (P = .16).

Conclusions

EEG-confirmed seizures are uncommon in patients with ICH secondary to AVM rupture; however, when identified, the seizure burden appears to be high. Patients with seizures 30 days after AVM rupture are more likely to develop epilepsy.

研究目的评估癫痫的临床和脑电图（EEG）预测因素，并描述因动静脉畸形（AVM）破裂导致的自发性脑内出血（ICH）患者中电图癫痫发作（ES）和癫痫发展的百分比：研究设计：对11年来因动、静脉畸形（AVM）破裂导致自发性脑内出血（ICH）而入住儿科重症监护室的患者进行回顾性研究。通过查看电子病历收集临床变量。癫痫发作被描述为急性症状（动静脉畸形破裂后 7 天）、亚急性（动静脉畸形破裂后 7-30 天）和远期（动静脉畸形破裂后 30 天以上）。结果指标包括死亡率和出院后癫痫的发生率。研究采用了描述性统计方法：43名患者符合纳入标准，中位年龄为12.2岁（IQR为7.3-14.8），49%（21/43）为女性。16%的患者（7/43）在接受脑电图检查前出现临床癫痫发作。62%的患者（27/43）接受了脑电图检查；其中一名患者有无临床症状的电图癫痫状态。16%的患者（7/43）被确诊为癫痫，中位确诊时间为 AVM 破裂后 1.34 年（IQR 0.55-2.07）。一年无癫痫生存率为 84%（95% CI 70%-98%），两年无癫痫生存率为 79%（95% CI 63%-95%）：脑电图确诊的癫痫发作在因动静脉畸形破裂继发 ICH 的患者中并不常见；但一旦确诊，癫痫发作的负担似乎很高。在动静脉畸形破裂 30 天后出现癫痫发作的患者更有可能发展为癫痫。

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引用次数: 0

Validation of the Dutch Infant Crying and Parent Well-Being Screening Tool in Parents of Infants Less than 12 Months of Age 荷兰婴儿哭闹和父母幸福感 (ICPW) 筛查工具在 12 个月以下婴儿父母中的验证。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-27 DOI: 10.1016/j.jpeds.2024.114326

Karola de Graaf MD , Yael E.P. Kwakman BSc , Ineke de Kruijff MD, PhD , Ellen Tromp PhD , Ingrid I.E. Staal PhD , Leslie E. Katch PhD , Tiffany Burkhardt PhD , Marc A. Benninga MD, PhD , Tessa J. Roseboom PhD , Arine M. Vlieger MD, PhD

Objective

To evaluate reliability and validity of the Dutch version of the Infant Crying and Parent Well-Being (ICPW) tool in identifying parents struggling with infant crying in the first year of life.

Study design

The original ICPW tool was translated into Dutch following established guidelines. The internal consistency and criterion validity of the Dutch ICPW tool were evaluated using a cross-sectional design. The translated ICPW tool and validated questionnaires on parental depression, stress, anxiety, and parenting balance were presented to parents of infants under 12 months during child health care visits and online.

Results

The survey was completed by 488 parents, 400 mothers and 88 fathers. Of these, 172 participated after a child health care visit and 316 via online platforms. The Dutch ICPW showed satisfactory internal consistency (α = 0.69) and excellent criterion validity with parental mental health measures (r = 0.53-0.85). ICPW scores demonstrated positive correlations with parental depression, stress, and anxiety levels, and a negative correlation with parenting balance. Both mothers and fathers with a positive ICPW screen (≥3) reported significantly higher levels of parental mental health issues compared with those with a negative screen (P < .001). The ICPW was positive in 32% of the parents (n = 155), with consistent total scores regardless of the infant's increasing age (r = −0.024, P = .59). The ICPW tool exhibited a strong negative predictive value (93%) for diagnosing postpartum depression.

Conclusions

The Dutch ICPW tool is a reliable and valid screening instrument for identifying parents struggling with infant crying.

目的：评估荷兰语版《婴儿哭闹与父母福祉》（ICPW）工具在识别婴儿出生后第一年内哭闹的父母方面的可靠性和有效性：评估荷兰语版 "婴儿哭闹与父母幸福（ICPW）"工具的可靠性和有效性，以识别在婴儿出生后第一年内与婴儿哭闹作斗争的父母：研究设计：按照既定准则将原版 ICPW 工具翻译成荷兰语。采用横断面设计对荷兰语 ICPW 工具的内部一致性和标准有效性进行了评估。翻译后的 ICPW 工具和经过验证的关于父母抑郁、压力、焦虑和养育平衡的调查问卷在儿童医疗保健就诊期间和网上提供给了 12 个月以下婴儿的父母：共有 488 名家长完成了调查，其中母亲 400 人，父亲 88 人。其中，172 人是在儿童保健就诊后参与调查的，316 人是通过在线平台参与调查的。荷兰语 ICPW 的内部一致性（α = 0.69）令人满意，与父母心理健康测量的标准效度（r = 0.53-0.85）极佳。ICPW 分数与父母的抑郁、压力和焦虑水平呈正相关，与养育平衡呈负相关。ICPW筛查结果呈阳性（≥3）的母亲和父亲与筛查结果呈阴性（p < 0.001）的母亲和父亲相比，其父母的心理健康问题水平明显更高。32%的父母（n=155）的ICPW筛查结果呈阳性，无论婴儿的年龄增长与否，其总分都是一致的（r = -0.024，p = 0.59）。ICPW 工具对产后抑郁症的诊断具有很高的阴性预测值（93%）：荷兰 ICPW 工具是一种可靠有效的筛查工具，可用于识别因婴儿哭闹而挣扎的父母。

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引用次数: 0

Crohn's Disease Presenting as Orofacial Granulomatosis 克罗恩病表现为口面部肉芽肿病。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-24 DOI: 10.1016/j.jpeds.2024.114324

Samantha Epstein BS, Stephen Somach MD, Lisa Gelles MD

引用次数: 0

Disruption of the Circulating Proteome in Neonates Receiving Extracorporeal Membrane Oxygenation Following Congenital Heart Disease Surgery: A Nested Case-Control Study 先天性心脏病手术后接受体外膜氧合的新生儿循环蛋白质组的破坏：一项嵌套病例对照研究。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-19 DOI: 10.1016/j.jpeds.2024.114322

Lindsay M. Thomson MD , Sierra Niemiec MS , Christopher A. Mancuso PhD , Ludmila Khailova MS , Eiman Ali MBBS , Aneesa Syed BS, MBA , Kelly R. Wolfe PhD , Jack Zakrzewski MD , Matthew Stone MD, PhD , Robert Hyslop RN , Benjamin S. Frank MD , Jesse A. Davidson MD, MPH, MSc

This nested case-control study identified broad dysregulation of the circulating proteome in neonates receiving postoperative extracorporeal membrane oxygenation support after congenital heart disease surgery, including differential responses in those not surviving to hospital discharge. Tissue hypoxia and mitochondrial-associated proteins may represent novel candidate biomarkers for poor extracorporeal membrane oxygenation outcomes.

这项巢式病例对照研究发现，在先天性心脏病手术后接受体外膜氧合（ECMO）支持的新生儿中，循环蛋白质组出现了广泛的失调，包括那些未能存活到出院的新生儿的不同反应。组织缺氧和线粒体相关蛋白可能是导致 ECMO 不良后果的新型候选生物标志物。

引用次数: 0

Measuring Up: Do Pediatric Endocrinology Fellows’ Career Expectations Align with Workforce Reality? 量力而行：儿科内分泌学研究员的职业期望与劳动力现实相符吗？

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-19 DOI: 10.1016/j.jpeds.2024.114321

Leena Nahata MD , Shylaja Srinivasan MD, MAS , Charleen I. Roche BA , Karla F. Leavens MD, PhD , Mimi S. Kim MD, MSc , Amy Levenson MD , Lisa Swartz Topor MD, MMSc , Kanakadurga Singer MA, MD , Shana McCormack MD, MTR

引用次数: 0

Maternal Diabetes and Neurodevelopmental Outcomes of Infants Born Before 29 Weeks’ Gestation 妊娠 29 周前出生婴儿的母亲糖尿病与神经发育结果。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-19 DOI: 10.1016/j.jpeds.2024.114319

Adetokunbo Akinseye MBBS , Christy Pylypjuk MD, MSc , Diane Moddemann MD, MEd , Jehier Afifi MBBCh, MSc , Rudaina Banihani MD, MHPE , Khalid Aziz MBBS, MEd (IT) , Dianna Wang MD , Mary Seshia MBChB

Objective

To compare the neurodevelopmental outcomes of infants born at <29 weeks’ gestation and exposed to diabetes in pregnancy with those unexposed.

Study design

This was a retrospective cohort study using the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases. Infants born <29 weeks’ gestation and admitted to a level 3 neonatal intensive care unit from 2009 through 2018 who had neurodevelopmental assessments at 18-24 months corrected age were eligible. The 2 primary outcomes were as follows: (1) Neurodevelopmental impairment (NDI) (≥1 of Bayley-III scores < 85 in any domain, cerebral palsy, or vision or hearing impairment); and (2) significant NDI (sNDI) (≥1 of Bayley-III scores < 70 in any domain, cerebral palsy Gross Motor Function Classification System ≥ 3, bilateral blindness, or need for hearing aids or cochlear implants). Secondary outcomes were the individual components of NDI and sNDI. Adjusted odds ratios with 95% CIs were calculated to determine outcomes between groups.

Results

Of 13 988 eligible infants, 55% attended neurodevelopmental follow-up assessments. Infants exposed to diabetes had increased odds of NDI compared with those unexposed (aOR 1.09 (95% CI 1.08-1.54); there was no difference in sNDI (aOR 1.07 (95% CI 0.84-1.36). Language and motor delays were more common in those exposed to maternal diabetes.

Conclusions

Higher rates of NDI, language, or motor delays were present in infants born at <29 weeks' gestation exposed to diabetes in utero. Future research is needed to determine the etiology and clinical significance of these findings.

研究目的比较在加拿大出生的婴儿的神经发育结果研究设计：这是一项使用加拿大新生儿网络（CNN）和加拿大新生儿随访网络（CNFUN）数据库进行的回顾性队列研究。出生婴儿结果在 13,988 名符合条件的婴儿中，55% 接受了神经发育随访评估。与未患糖尿病的婴儿相比，患 NDI 的几率更高（aOR 1.09 (95% CI 1.08-1.54)）；患 sNDI 的几率没有差异（aOR 1.07 (95% CI 0.84-1.36)）。母婴糖尿病患儿的语言和运动发育迟缓更为常见：结论：妊娠期小于 29 周、在宫内感染糖尿病的婴儿出现 NDI、语言或运动迟缓的比例较高。未来的研究需要确定这些发现的病因和临床意义。

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引用次数: 0

The Impact of Hospital Delivery Volumes of Newborns Born Very Preterm on Mortality and Morbidity 极早产儿的住院分娩量对死亡率和发病率的影响。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-18 DOI: 10.1016/j.jpeds.2024.114323

Ciaran S. Phibbs PhD , Molly Passarella MS , Susan K. Schmitt RN, PhD , Ashley Martin MPH , Scott A. Lorch MD, MSCE

Objective

To examine if the annual patient volume of infants born very preterm (VPT, gestational age <32 weeks) at a hospital is associated with neonatal mortality and morbidity.

Study design

We performed an observational, secondary data analysis using a 20-year panel of birth certificates linked to hospital discharge abstracts, including transfers in California, Michigan, Missouri, Oregon, Pennsylvania, and South Carolina from 1996 through 2015. The study included all in-hospital VPT deliveries (n = 208 261). Study outcomes were in-hospital mortality or serious morbidity (intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, or bronchopulmonary dysplasia), attributed to the hospital of birth. Poisson regression models estimated the risk-adjusted relative risk (RR) for mortality and serious morbidity across different patient volume categories within a given hospital using hospital fixed effects.

Results

The risk of mortality and serious morbidity for VPT infants increased as the number of infants born VPT at a hospital decreased. Compared with VPT delivery volumes >100 infants per year, the risk of mortality increased when a given hospital had VPT delivery volumes < 60 per year, ranging from a RR of 1.13 (95% C.I. 1.02-1.25) for volumes between 50 to 59 and 1.39 (1.19-1.62) for VPT volumes <10, and the risk of mortality or serious morbidity increased when a given hospital had VPT volumes <100, ranging from a RR of 1.05 (1.02-1.08) for volumes between 90 to 99 and 1.27 (1.19-1.36) for VPT volumes <10.

Conclusions

These results suggest that, for VPT infants, the risk of both mortality and mortality or serious morbidity is increased as the VPT volume within a given hospital declines.

研究目的研究设计：我们使用与医院出院摘要关联的出生证明面板进行了为期 20 年的观察性二次数据分析，其中包括 1996 年至 2015 年期间在加利福尼亚州、密歇根州、密苏里州、俄勒冈州、宾夕法尼亚州和南卡罗来纳州的转院情况。该研究包括所有院内 VPT 分娩（N=208,261）。研究结果为出生医院导致的院内死亡率或严重发病率（脑室内出血、坏死性小肠结肠炎、早产儿视网膜病变或支气管肺发育不良）。泊松回归模型利用医院固定效应估算了特定医院内不同患者数量类别的死亡率和严重发病率的风险调整相对风险（RR）：结果：VPT 婴儿的死亡和严重发病风险随着医院 VPT 婴儿出生人数的减少而增加。与每年 VPT 分娩量大于 100 名婴儿相比，当某医院每年 VPT 分娩量小于 60 名婴儿时，死亡风险增加，从 50 至 59 名婴儿的 RR 值 1.13（95% C.I.1.02-1.25）到 VPT 分娩量的 RR 值 1.39（1.19-1.62）不等：这些结果表明，对于 VPT 婴儿来说，随着特定医院内 VPT 容量的减少，死亡和死亡或严重发病的风险都会增加。

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IF 3.9 2区医学 Q1 PEDIATRICS

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Pub Date : 2024-09-18 DOI: 10.1016/j.jpeds.2024.114320

David R. Jacobs Jr. PhD, Jessica G. Woo PhD, Stephen R. Daniels MD, PhD

引用次数: 0

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IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-09-17 DOI: 10.1016/S0022-3476(24)00364-0

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IF 3.9 2区医学 Q1 PEDIATRICS

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Pub Date : 2024-09-17 DOI: 10.1016/j.jpeds.2024.114281

Sarah S. Long MD

引用次数: 0

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