Pub Date : 2024-11-20DOI: 10.1016/j.jpeds.2024.114414
Alan M Groves, Monica M Bennett, John Loyd, Reese H Clark, Veeral N Tolia
Objective: To describe the trends in percentage oxygen requirement and mode of respiratory support delivered to extremely premature infants in the 12 weeks after birth.
Study design: This is a retrospective study of extremely premature infants (≤276/7 weeks) discharged from neonatal intensive care units managed by Pediatrix Medical Group between January 1, 2016, and December 31, 2021. Demographic and daily clinical data (mode of respiratory support and fraction of inspired oxygen [FiO2]) were extracted from the Pediatrix Clinical Data Warehouse.
Results: A total of 16 386 infants with a median gestational age of 25 weeks and birthweight of 765 g were included. There were 3808 (23.2%) infants who died. Of the cohort, 6019 (43.1%) infants who survived to 36 weeks' gestation had bronchopulmonary dysplasia. Median FiO2 at all gestations followed a biphasic pattern with a peak on day of life 1, reduction to a nadir by day 4 to 5, and an increase to a second peak around day 14. Infants born at lower gestational ages had a higher median FiO2 at each time point. At lower gestations, there were higher proportions of infants receiving mechanical ventilation and a later introduction of noninvasive modes.
Conclusions: Extremely premature infants show a consistent biphasic pattern in percentage of supplemental oxygen required after birth.
{"title":"Trajectory of Postnatal Oxygen Requirement in Extremely Preterm Infants.","authors":"Alan M Groves, Monica M Bennett, John Loyd, Reese H Clark, Veeral N Tolia","doi":"10.1016/j.jpeds.2024.114414","DOIUrl":"10.1016/j.jpeds.2024.114414","url":null,"abstract":"<p><strong>Objective: </strong>To describe the trends in percentage oxygen requirement and mode of respiratory support delivered to extremely premature infants in the 12 weeks after birth.</p><p><strong>Study design: </strong>This is a retrospective study of extremely premature infants (≤27<sup>6/7</sup> weeks) discharged from neonatal intensive care units managed by Pediatrix Medical Group between January 1, 2016, and December 31, 2021. Demographic and daily clinical data (mode of respiratory support and fraction of inspired oxygen [FiO<sub>2</sub>]) were extracted from the Pediatrix Clinical Data Warehouse.</p><p><strong>Results: </strong>A total of 16 386 infants with a median gestational age of 25 weeks and birthweight of 765 g were included. There were 3808 (23.2%) infants who died. Of the cohort, 6019 (43.1%) infants who survived to 36 weeks' gestation had bronchopulmonary dysplasia. Median FiO<sub>2</sub> at all gestations followed a biphasic pattern with a peak on day of life 1, reduction to a nadir by day 4 to 5, and an increase to a second peak around day 14. Infants born at lower gestational ages had a higher median FiO<sub>2</sub> at each time point. At lower gestations, there were higher proportions of infants receiving mechanical ventilation and a later introduction of noninvasive modes.</p><p><strong>Conclusions: </strong>Extremely premature infants show a consistent biphasic pattern in percentage of supplemental oxygen required after birth.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114414"},"PeriodicalIF":3.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-17DOI: 10.1016/j.jpeds.2024.114408
Jacqueline M Lauer, Juha Pyykkö, Mpela Chembe, Tamara Billima-Mulenga, Dorothy Sikazwe, Bertha Chibwe, Savanna Henderson, Doug Parkerson, Jukka M Leppänen, Günther Fink, Lindsey M Locks, Peter C Rockers
Objective: To examine cross-sectional relationships between biomarkers of environmental enteric dysfunction (EED), an acquired subclinical condition of the small intestine, and anthropometric and developmental outcomes among children in Lusaka, Zambia.
Study design: Serum samples were collected from 240 children aged 27 to 35 months enrolled in a cluster-randomized trial assessing the effects of growth charts and small-quantity lipid-based nutrient supplements on linear growth. Samples were analyzed using the 11-plex Micronutrient and EED Assessment Tool, which incorporates 2 biomarkers of EED, namely intestinal fatty acid-binding protein (I-FABP), a marker of epithelial damage, and soluble CD14 (sCD14), a marker of microbial translocation. Associations between log2-transformed biomarker concentrations and anthropometric (height-for-age z-score [HAZ], weight-for-height z-score, and weight-for-age z-score) and developmental (Global Scales of Early Development development for age z-score and saccadic reaction time [SRT]) outcomes were assessed using linear regression analyses adjusted for background characteristics.
Results: Mean ± SD HAZ was -1.94 ± 1.10. Higher sCD14 and I-FABP concentrations were significantly associated with lower HAZ (β: -0.21, 95% CI: -0.41, -0.01 and β: -0.20, 95% CI: -0.32, -0.08, respectively). Higher I-FABP concentrations were significantly associated with lower development-for-age z-score (β: -0.22, 95% CI: -0.40, -0.03) and slower SRT (β: 7.37 ms, 95% CI: 2.02, 12.72) as were higher alpha-1-acid glycoprotein concentrations (HAZ β: -0.38, 95% CI: -0.72, -0.03; SRT β: 11.14 ms, 95% CI: 0.94, 21.72).
Conclusions: In children in Lusaka, biomarkers of EED were associated with poor anthropometric and developmental outcomes, underscoring the need for interventions to address EED to improve child health globally.
Clinical trial registry: ClinicalTrials.gov identifier for parent trial: NCT05120427. https://clinicaltrials.gov/ct2/show/NCT05120427.
{"title":"Markers of Environmental Enteric Dysfunction are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia.","authors":"Jacqueline M Lauer, Juha Pyykkö, Mpela Chembe, Tamara Billima-Mulenga, Dorothy Sikazwe, Bertha Chibwe, Savanna Henderson, Doug Parkerson, Jukka M Leppänen, Günther Fink, Lindsey M Locks, Peter C Rockers","doi":"10.1016/j.jpeds.2024.114408","DOIUrl":"10.1016/j.jpeds.2024.114408","url":null,"abstract":"<p><strong>Objective: </strong>To examine cross-sectional relationships between biomarkers of environmental enteric dysfunction (EED), an acquired subclinical condition of the small intestine, and anthropometric and developmental outcomes among children in Lusaka, Zambia.</p><p><strong>Study design: </strong>Serum samples were collected from 240 children aged 27 to 35 months enrolled in a cluster-randomized trial assessing the effects of growth charts and small-quantity lipid-based nutrient supplements on linear growth. Samples were analyzed using the 11-plex Micronutrient and EED Assessment Tool, which incorporates 2 biomarkers of EED, namely intestinal fatty acid-binding protein (I-FABP), a marker of epithelial damage, and soluble CD14 (sCD14), a marker of microbial translocation. Associations between log<sub>2</sub>-transformed biomarker concentrations and anthropometric (height-for-age z-score [HAZ], weight-for-height z-score, and weight-for-age z-score) and developmental (Global Scales of Early Development development for age z-score and saccadic reaction time [SRT]) outcomes were assessed using linear regression analyses adjusted for background characteristics.</p><p><strong>Results: </strong>Mean ± SD HAZ was -1.94 ± 1.10. Higher sCD14 and I-FABP concentrations were significantly associated with lower HAZ (β: -0.21, 95% CI: -0.41, -0.01 and β: -0.20, 95% CI: -0.32, -0.08, respectively). Higher I-FABP concentrations were significantly associated with lower development-for-age z-score (β: -0.22, 95% CI: -0.40, -0.03) and slower SRT (β: 7.37 ms, 95% CI: 2.02, 12.72) as were higher alpha-1-acid glycoprotein concentrations (HAZ β: -0.38, 95% CI: -0.72, -0.03; SRT β: 11.14 ms, 95% CI: 0.94, 21.72).</p><p><strong>Conclusions: </strong>In children in Lusaka, biomarkers of EED were associated with poor anthropometric and developmental outcomes, underscoring the need for interventions to address EED to improve child health globally.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov identifier for parent trial: NCT05120427. https://clinicaltrials.gov/ct2/show/NCT05120427.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114408"},"PeriodicalIF":3.9,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-17DOI: 10.1016/j.jpeds.2024.114412
Renée A Shellhaas, Linda S Franck, Betsy Pilon, Courtney J Wusthoff, Shavonne L Massey, Catherine J Chu, Janet S Soul, Monica E Lemmon, Adam L Numis, Julie S Sturza, Cameron Thomas, Giulia M Benedetti, Stephanie M D Rau, Tayyba Anwar, Madison M Berl, Charles E McCulloch, Hannah C Glass
Objective: To evaluate whether abnormal sleep is associated with adverse outcomes for children who survived acute provoked neonatal seizures, and their parents.
Study design: This 9-center study prospectively followed newborns with acute provoked seizures. When children reached age 5 years, parents completed the Children's Sleep Habits Questionnaire (CSHQ), the Pediatric Sleep Questionnaire-Sleep Related Breathing Disorders (PSQ-SRBD) subscale, the Vineland Adaptive Behavior Scales-3, and the Hospital Anxiety Depression Scale. Children were also assessed with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Spearman correlations and multivariable analyses were used to evaluate risk factors for sleep problems.
Results: The mean CSHQ score was 45 ± 7; 77 of 118 children (65%) had an abnormal score (above the healthy sleep threshold of 41). On the PSQ-SRBD, 32 of 119 children (27%) screened positive for sleep-disordered breathing (SDB). SDB symptoms were more common among children with cerebral palsy (42% with vs 22% without; P = .03) and epilepsy (54% with vs 24% without; P = .02). Children with lower scores on the Vineland-3 (rho = -0.25; P = .01) and WPPSI-IV (rho = -0.31; P = .004) at 5 years of age were more likely to have symptoms of SDB. Worse CSHQ and PSQ-SRBD scores were associated with higher parental anxiety (rho = 0.28 [P = .002] and rho = 0.34 [P = .0002], respectively) and depression scores on the Hospital Anxiety Depression Scale (rho = 0.16 [P = .08] and rho = 0.17 [P = .07], respectively).
Conclusions: Two-thirds of early school-aged survivors of acute provoked neonatal seizures had parent-reported sleep abnormalities and one-quarter screened positive for SDB. Early screening and effective treatment for sleep disorders could be an innovative, practice-changing approach to improve outcomes after neonatal seizures.
{"title":"Sleep Disorders Five Years After Acute Provoked Neonatal Seizures.","authors":"Renée A Shellhaas, Linda S Franck, Betsy Pilon, Courtney J Wusthoff, Shavonne L Massey, Catherine J Chu, Janet S Soul, Monica E Lemmon, Adam L Numis, Julie S Sturza, Cameron Thomas, Giulia M Benedetti, Stephanie M D Rau, Tayyba Anwar, Madison M Berl, Charles E McCulloch, Hannah C Glass","doi":"10.1016/j.jpeds.2024.114412","DOIUrl":"10.1016/j.jpeds.2024.114412","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether abnormal sleep is associated with adverse outcomes for children who survived acute provoked neonatal seizures, and their parents.</p><p><strong>Study design: </strong>This 9-center study prospectively followed newborns with acute provoked seizures. When children reached age 5 years, parents completed the Children's Sleep Habits Questionnaire (CSHQ), the Pediatric Sleep Questionnaire-Sleep Related Breathing Disorders (PSQ-SRBD) subscale, the Vineland Adaptive Behavior Scales-3, and the Hospital Anxiety Depression Scale. Children were also assessed with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Spearman correlations and multivariable analyses were used to evaluate risk factors for sleep problems.</p><p><strong>Results: </strong>The mean CSHQ score was 45 ± 7; 77 of 118 children (65%) had an abnormal score (above the healthy sleep threshold of 41). On the PSQ-SRBD, 32 of 119 children (27%) screened positive for sleep-disordered breathing (SDB). SDB symptoms were more common among children with cerebral palsy (42% with vs 22% without; P = .03) and epilepsy (54% with vs 24% without; P = .02). Children with lower scores on the Vineland-3 (rho = -0.25; P = .01) and WPPSI-IV (rho = -0.31; P = .004) at 5 years of age were more likely to have symptoms of SDB. Worse CSHQ and PSQ-SRBD scores were associated with higher parental anxiety (rho = 0.28 [P = .002] and rho = 0.34 [P = .0002], respectively) and depression scores on the Hospital Anxiety Depression Scale (rho = 0.16 [P = .08] and rho = 0.17 [P = .07], respectively).</p><p><strong>Conclusions: </strong>Two-thirds of early school-aged survivors of acute provoked neonatal seizures had parent-reported sleep abnormalities and one-quarter screened positive for SDB. Early screening and effective treatment for sleep disorders could be an innovative, practice-changing approach to improve outcomes after neonatal seizures.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114412"},"PeriodicalIF":3.9,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-17DOI: 10.1016/j.jpeds.2024.114413
Tina Tarnawsky, Inez Y Oh, Ethan Hillis, Aditi Gupta, David H Gutmann
There are few centers with combined pediatric and adult neurofibromatosis 1 practices and transition of care programming. Using an electronic health records-based approach, we found an early death peak in the fourth decade of life largely owing to malignancy, underscoring the need for integrated neurological training and practice across the lifespan.
{"title":"Early Young Adult Death Underscores the Need for Adolescent and Young Adult Transition Programs in Neurofibromatosis Type 1.","authors":"Tina Tarnawsky, Inez Y Oh, Ethan Hillis, Aditi Gupta, David H Gutmann","doi":"10.1016/j.jpeds.2024.114413","DOIUrl":"10.1016/j.jpeds.2024.114413","url":null,"abstract":"<p><p>There are few centers with combined pediatric and adult neurofibromatosis 1 practices and transition of care programming. Using an electronic health records-based approach, we found an early death peak in the fourth decade of life largely owing to malignancy, underscoring the need for integrated neurological training and practice across the lifespan.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114413"},"PeriodicalIF":3.9,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.jpeds.2024.114409
Courtney Temple, Emma Cassidy, Robert G Hendrickson
Children exposed to illicit fentanyl often experience severe toxicity and receive repeated naloxone doses and prolonged airway support. This retrospective study presents the clinical course and management of 4 cases, emphasizing the urgent need for prompt recognition and intervention to address the severe, extended effects of illicit fentanyl exposure in very young children.
{"title":"Characteristics of Fentanyl Toxicity in Very Young Children.","authors":"Courtney Temple, Emma Cassidy, Robert G Hendrickson","doi":"10.1016/j.jpeds.2024.114409","DOIUrl":"10.1016/j.jpeds.2024.114409","url":null,"abstract":"<p><p>Children exposed to illicit fentanyl often experience severe toxicity and receive repeated naloxone doses and prolonged airway support. This retrospective study presents the clinical course and management of 4 cases, emphasizing the urgent need for prompt recognition and intervention to address the severe, extended effects of illicit fentanyl exposure in very young children.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114409"},"PeriodicalIF":3.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.jpeds.2024.114411
Marie-Coralie Cornet, Adam L Numis, Sarah E Monsell, Natalie H Chan, Fernando F Gonzalez, Bryan A Comstock, Sandra E Juul, Courtney J Wusthoff, Yvonne W Wu, Hannah C Glass
Objective: To assess the relationship between the Sarnat exam, early electroencephalogram (EEG) background, and death or neurodevelopmental impairment (NDI) at age 2 years among neonates with moderate to severe hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.
Study design: Neonates enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy trial with EEG (n = 463) or amplitude-integrated electroencephalogram (n = 15) reports available on the first day after birth were included in this cohort study. A Sarnat exam was performed between 1 and 6 hours after birth, and neonates were classified into 3 groups of increasing severity based on the number of severe features (none, 1-2, or 3+). EEG background continuity was extracted from reports and categorized as normal, excessively discontinuous, or severely abnormal. The primary outcome was severe NDI or death at age 2.
Results: Among 478 neonates with hypoxic-ischemic encephalopathy, EEG background continuity was normal in 186 (39%), excessively discontinuous in 171 (36%), and severely abnormal in 121 (25%). For each additional severe feature on the Sarnat exam, the risk of abnormal EEG background increased by 16% (relative risk 1.16 [95% CI 1.09-1.23]). Both the Sarnat exam and EEG background severity were associated with an increased risk of severe NDI or death. After adjusting for Sarnat exam severity, severe EEG background remained associated with severe NDI and death (relative risk 5.7 [95% CI 3.7-8.9]).
Conclusions: The early EEG background provides additional information beyond the Sarnat exam and could be an additional early marker when assessing the severity of HIE.
研究目的评估接受治疗性低温的中重度缺氧缺血性脑病(HIE)新生儿的萨纳特检查、早期脑电图(EEG)背景与两岁时死亡或神经发育障碍(NDI)之间的关系:研究设计:参加 "高剂量促红细胞生成素治疗窒息和脑病(HEAL)"试验的新生儿在出生后第一天即可获得脑电图(463 例)或 aEEG(15 例)报告,这些新生儿被纳入本队列研究。新生儿在出生后 1 到 6 小时之间进行 Sarnat 检查,并根据严重特征的数量(无、1 到 2 或 3+)将其分为严重程度依次递增的三组。从报告中提取脑电图背景连续性,并将其分为正常、过度不连续或严重异常。主要结果是两岁时出现严重NDI或死亡:在 478 例 HIE 新生儿中,186 例(39%)脑电图背景连续性正常,171 例(36%)过度不连续,121 例(25%)严重异常。萨纳特检查每增加一个严重特征,脑电图背景异常的风险就增加 16% (RR 1.16 [95% CI 1.09-1.23])。萨纳特检查和脑电图背景严重程度都与严重 NDI 或死亡风险的增加有关。调整 Sarnat 检查严重程度后,严重脑电图背景仍与严重 NDI 和死亡相关(RR 5.7 [95% CI 3.7-8.9]):结论:早期脑电图背景提供了 Sarnat 检查以外的额外信息,可作为评估 HIE 严重程度的额外早期标志物。
{"title":"Assessing Early Severity of Hypoxic-Ischemic Encephalopathy: The Role of Electroencephalogram Background in Addition to Sarnat Exam.","authors":"Marie-Coralie Cornet, Adam L Numis, Sarah E Monsell, Natalie H Chan, Fernando F Gonzalez, Bryan A Comstock, Sandra E Juul, Courtney J Wusthoff, Yvonne W Wu, Hannah C Glass","doi":"10.1016/j.jpeds.2024.114411","DOIUrl":"10.1016/j.jpeds.2024.114411","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between the Sarnat exam, early electroencephalogram (EEG) background, and death or neurodevelopmental impairment (NDI) at age 2 years among neonates with moderate to severe hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.</p><p><strong>Study design: </strong>Neonates enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy trial with EEG (n = 463) or amplitude-integrated electroencephalogram (n = 15) reports available on the first day after birth were included in this cohort study. A Sarnat exam was performed between 1 and 6 hours after birth, and neonates were classified into 3 groups of increasing severity based on the number of severe features (none, 1-2, or 3+). EEG background continuity was extracted from reports and categorized as normal, excessively discontinuous, or severely abnormal. The primary outcome was severe NDI or death at age 2.</p><p><strong>Results: </strong>Among 478 neonates with hypoxic-ischemic encephalopathy, EEG background continuity was normal in 186 (39%), excessively discontinuous in 171 (36%), and severely abnormal in 121 (25%). For each additional severe feature on the Sarnat exam, the risk of abnormal EEG background increased by 16% (relative risk 1.16 [95% CI 1.09-1.23]). Both the Sarnat exam and EEG background severity were associated with an increased risk of severe NDI or death. After adjusting for Sarnat exam severity, severe EEG background remained associated with severe NDI and death (relative risk 5.7 [95% CI 3.7-8.9]).</p><p><strong>Conclusions: </strong>The early EEG background provides additional information beyond the Sarnat exam and could be an additional early marker when assessing the severity of HIE.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114411"},"PeriodicalIF":3.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.jpeds.2024.114407
Mathies Rondagh, Linda S de Vries, Andrea van Steenis, Unoke Meder, Laszlo Szakacs, Agnes Jermendy, Sylke J Steggerda
Objectives: To validate the prognostic accuracy of a previously published tool (HOPE calculator) using longitudinal analysis of amplitude-integrated electroencephalography (aEEG) background activity and sleep-wake cycling to predict favorable or adverse 2-year neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH), and to evaluate the predictive value for outcome at 5-8 years of age.
Study design: Single-center retrospective cohort study in 117 infants who underwent TH for HIE between 2008 and 2022. We scored 2-channel aEEG BGPs, sleep-wake cycling, and seizure activity at 6-hour intervals for 84 hours. Neurodevelopmental outcome at 2 years was evaluated using the Bayley Scales of Infant Development-III, defining adverse outcome as death, cerebral palsy, and/or cognitive/motor scores of <85. Adverse outcome at 5-8 years was defined as a total IQ score of <85, a Movement-ABC-2 score of less than p15, cerebral palsy, severe sensory impairment, or death.
Results: The prediction model showed an area under the curve of 0.90 (95% CI, 0.83-0.95) at 2 years and 0.83 (95% CI, 0.73-0.92) at 5-8 years. Mean predicted probability of favorable outcome was 74.5% (95% CI, 69.4-79.6) in the favorable outcome group compared with 32.8% (95% CI, 23.5-42.2) in the adverse outcome group (P < .001) at 2 years (n = 115) and 76.85% (95% CI, 70.0-83.4) compared with 40.7% (95% CI, 30.0-51.4) at 5-8 years (n = 68).
Conclusions: Our study provided external validation of the HOPE calculator, assessing longitudinal aEEG background activity during TH in infants with HIE. The results suggest that this method can predict favorable or adverse outcomes accurately not only at 2 but also at 5-8 years of age.
{"title":"Longitudinal Analysis of Amplitude-Integrated Electroencephalography for Outcome Prediction in Infants with Hypoxic-Ischemic Encephalopathy: A Validation Study.","authors":"Mathies Rondagh, Linda S de Vries, Andrea van Steenis, Unoke Meder, Laszlo Szakacs, Agnes Jermendy, Sylke J Steggerda","doi":"10.1016/j.jpeds.2024.114407","DOIUrl":"10.1016/j.jpeds.2024.114407","url":null,"abstract":"<p><strong>Objectives: </strong>To validate the prognostic accuracy of a previously published tool (HOPE calculator) using longitudinal analysis of amplitude-integrated electroencephalography (aEEG) background activity and sleep-wake cycling to predict favorable or adverse 2-year neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH), and to evaluate the predictive value for outcome at 5-8 years of age.</p><p><strong>Study design: </strong>Single-center retrospective cohort study in 117 infants who underwent TH for HIE between 2008 and 2022. We scored 2-channel aEEG BGPs, sleep-wake cycling, and seizure activity at 6-hour intervals for 84 hours. Neurodevelopmental outcome at 2 years was evaluated using the Bayley Scales of Infant Development-III, defining adverse outcome as death, cerebral palsy, and/or cognitive/motor scores of <85. Adverse outcome at 5-8 years was defined as a total IQ score of <85, a Movement-ABC-2 score of less than p15, cerebral palsy, severe sensory impairment, or death.</p><p><strong>Results: </strong>The prediction model showed an area under the curve of 0.90 (95% CI, 0.83-0.95) at 2 years and 0.83 (95% CI, 0.73-0.92) at 5-8 years. Mean predicted probability of favorable outcome was 74.5% (95% CI, 69.4-79.6) in the favorable outcome group compared with 32.8% (95% CI, 23.5-42.2) in the adverse outcome group (P < .001) at 2 years (n = 115) and 76.85% (95% CI, 70.0-83.4) compared with 40.7% (95% CI, 30.0-51.4) at 5-8 years (n = 68).</p><p><strong>Conclusions: </strong>Our study provided external validation of the HOPE calculator, assessing longitudinal aEEG background activity during TH in infants with HIE. The results suggest that this method can predict favorable or adverse outcomes accurately not only at 2 but also at 5-8 years of age.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114407"},"PeriodicalIF":3.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.jpeds.2024.114410
Michael S Toce, Claire Narang, Michael C Monuteaux, Florence T Bourgeois
Objective: To examine the relationship between the Child Opportunity Index (COI) and unintentional poisonings in a geographically diverse pediatric population.
Study design: We conducted a retrospective, case-control study of children ≤ 6 years of age who had emergency department encounters for poisonings from January 1, 2016, to December 31, 2021. Data were obtained from the Pediatric Health Information System database. Poisonings were categorized as related to prescription medications, over-the-counter medications, drugs of misuse, or nonmedicinal substances. We estimated multivariable conditional logistic regression models to examine the association of the COI with each poisoning type.
Results: Among 49 789 emergency department encounters for poisonings, the most common poisoning category was prescription medications (28.3%). Compared with patients with very low COI, patients with very high COI were more likely to present for prescription medication (aOR 1.15 [95% CI, 1.01-1.31]) or over-the-counter medication poisoning (aOR 1.37 [95% CI, 1.18-1.59]). Conversely, patients with very high COI were less likely to have poisonings secondary to drugs of misuse (aOR 0.82 [95% CI, 0.67-0.99]). Patients with high COI were also less likely to have poisonings due to a nonmedicinal substance compared with patients with very low COI (aOR 0.83 [95% CI, 0.73-0.93]).
Conclusions: Different pediatric poisoning types were associated with a patient's COI, possibly reflecting socioeconomic characteristics of a child's environment. While poison prevention strategies should be employed uniformly to maximize impact, our findings highlight variation in poisoning risks related to a child's environment and support the use of the COI for future research into mechanisms to strengthen further poisoning prevention strategies.
{"title":"The Association of the Child Opportunity Index with Emergency Department Presentations for Pediatric Poisonings: A Case-Control Study.","authors":"Michael S Toce, Claire Narang, Michael C Monuteaux, Florence T Bourgeois","doi":"10.1016/j.jpeds.2024.114410","DOIUrl":"10.1016/j.jpeds.2024.114410","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between the Child Opportunity Index (COI) and unintentional poisonings in a geographically diverse pediatric population.</p><p><strong>Study design: </strong>We conducted a retrospective, case-control study of children ≤ 6 years of age who had emergency department encounters for poisonings from January 1, 2016, to December 31, 2021. Data were obtained from the Pediatric Health Information System database. Poisonings were categorized as related to prescription medications, over-the-counter medications, drugs of misuse, or nonmedicinal substances. We estimated multivariable conditional logistic regression models to examine the association of the COI with each poisoning type.</p><p><strong>Results: </strong>Among 49 789 emergency department encounters for poisonings, the most common poisoning category was prescription medications (28.3%). Compared with patients with very low COI, patients with very high COI were more likely to present for prescription medication (aOR 1.15 [95% CI, 1.01-1.31]) or over-the-counter medication poisoning (aOR 1.37 [95% CI, 1.18-1.59]). Conversely, patients with very high COI were less likely to have poisonings secondary to drugs of misuse (aOR 0.82 [95% CI, 0.67-0.99]). Patients with high COI were also less likely to have poisonings due to a nonmedicinal substance compared with patients with very low COI (aOR 0.83 [95% CI, 0.73-0.93]).</p><p><strong>Conclusions: </strong>Different pediatric poisoning types were associated with a patient's COI, possibly reflecting socioeconomic characteristics of a child's environment. While poison prevention strategies should be employed uniformly to maximize impact, our findings highlight variation in poisoning risks related to a child's environment and support the use of the COI for future research into mechanisms to strengthen further poisoning prevention strategies.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114410"},"PeriodicalIF":3.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-12DOI: 10.1016/j.jpeds.2024.114394
Yinfang Wu, Weixing Xu
{"title":"Reconsidering Initial Respiratory Support Strategies in Infants Born Preterm.","authors":"Yinfang Wu, Weixing Xu","doi":"10.1016/j.jpeds.2024.114394","DOIUrl":"10.1016/j.jpeds.2024.114394","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114394"},"PeriodicalIF":3.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-12DOI: 10.1016/j.jpeds.2024.114396
Chelsea Weaver Krug, Alan L Mendelsohn, Jordan Wuerth, Erin Roby, Daniel S Shaw
Objective: To test the feasibility of implementing The Pittsburgh Study's (TPS) Early Childhood Collaborative, a population-level, community-partnered initiative to promote relational health by offering accessible preventive parenting program options for families with young children.
Study design: TPS partnered with healthcare and community agencies serving families in Allegheny County, Pennsylvania, to enroll and screen 878 parents of 1040 children 4-years-old and under. Participants were assigned to 1 of 4 tiered groups based on identified needs: (1) universal, (2) targeted/universal, (3) secondary/tertiary, or (4) tertiary programs. Parents were offered choices in empirically supported parenting programs within group ranging from texting programs to intensive home visiting. Program selection was optional. Chi-square tests were conducted to examine the likelihood of selecting a program by group.
Results: About 25% of participants were assigned to each tiered group; 78% of parents chose to enroll in a parenting program. In general, parents with higher levels of adversity were more likely to select a parenting program compared with those reporting less adversity, including secondary/tertiary vs targeted/universal groups (81.4% vs 72.8%), and tertiary vs universal and targeted/universal groups (83% vs 74.1% and 72.8%, respectively; P < .001).
Conclusions: Our high program enrollment rate supports the feasibility of TPS. TPS successfully engaged families in the study by offering choices in, and optimizing accessibility to, parenting programs. TPS is highly aligned with recent recommendations by the American Academy of Pediatrics for tiered approaches as part of a broad public health strategy for supporting early relational health.
Trial registration: The Pittsburgh Study Early Childhood (TPS-ECC): NCT05444205.
{"title":"The Pittsburgh Study: A Tiered Model to Support Parents during Early Childhood.","authors":"Chelsea Weaver Krug, Alan L Mendelsohn, Jordan Wuerth, Erin Roby, Daniel S Shaw","doi":"10.1016/j.jpeds.2024.114396","DOIUrl":"10.1016/j.jpeds.2024.114396","url":null,"abstract":"<p><strong>Objective: </strong>To test the feasibility of implementing The Pittsburgh Study's (TPS) Early Childhood Collaborative, a population-level, community-partnered initiative to promote relational health by offering accessible preventive parenting program options for families with young children.</p><p><strong>Study design: </strong>TPS partnered with healthcare and community agencies serving families in Allegheny County, Pennsylvania, to enroll and screen 878 parents of 1040 children 4-years-old and under. Participants were assigned to 1 of 4 tiered groups based on identified needs: (1) universal, (2) targeted/universal, (3) secondary/tertiary, or (4) tertiary programs. Parents were offered choices in empirically supported parenting programs within group ranging from texting programs to intensive home visiting. Program selection was optional. Chi-square tests were conducted to examine the likelihood of selecting a program by group.</p><p><strong>Results: </strong>About 25% of participants were assigned to each tiered group; 78% of parents chose to enroll in a parenting program. In general, parents with higher levels of adversity were more likely to select a parenting program compared with those reporting less adversity, including secondary/tertiary vs targeted/universal groups (81.4% vs 72.8%), and tertiary vs universal and targeted/universal groups (83% vs 74.1% and 72.8%, respectively; P < .001).</p><p><strong>Conclusions: </strong>Our high program enrollment rate supports the feasibility of TPS. TPS successfully engaged families in the study by offering choices in, and optimizing accessibility to, parenting programs. TPS is highly aligned with recent recommendations by the American Academy of Pediatrics for tiered approaches as part of a broad public health strategy for supporting early relational health.</p><p><strong>Trial registration: </strong>The Pittsburgh Study Early Childhood (TPS-ECC): NCT05444205.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114396"},"PeriodicalIF":3.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}