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Noninvasive Respiratory Support for Stabilization After Birth is a Safe Approach in Infants Who are Micropreterm 为稳定微早产儿出生后的状况而提供无创呼吸支持是一种安全的方法。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114395
Ayman Abou Mehrem MD, MSc, Marc Beltempo MD, MSc
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引用次数: 0
Subspecialty Perspectives on the Education Needs for Pediatrics Residency Training 亚专科对儿科住院医师培训教育需求的看法。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114380
Tandy Aye MD , David A. Turner MD , Angela S. Czaja MD, MSc, PhD , Cynthia M. Holland-Hall MD, MPH , Mary E. Moffatt MD , Patrick J. Myers MD , Jill J. Fussell MD , Council of Pediatric Subspecialties (CoPS)
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引用次数: 0
Trajectory of Postnatal Oxygen Requirement in Extremely Preterm Infants 极早产儿出生后的需氧量轨迹。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114414
Alan M. Groves MBChB , Monica M. Bennett PhD , John Loyd MD , Reese H. Clark MD , Veeral N. Tolia MD

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.
研究目的描述极早产儿出生后 12 周内的氧气需求百分比和呼吸支持方式的变化趋势:这是一项回顾性研究,研究对象为 2016 年 1 月 1 日至 2021 年 12 月 31 日期间从 Pediatrix 医疗集团管理的新生儿重症监护病房出院的极早产儿(≤27+6 周)。人口统计学和日常临床数据(呼吸支持模式和吸氧分数 [FiO2])均从 Pediatrix 临床数据仓库中提取:共纳入 16,386 名婴儿,中位胎龄为 25 周,出生体重为 765 克。3808名(23.2%)婴儿死亡。6,019名(43.1%)妊娠36周以内的存活婴儿患有支气管肺发育不良(BPD)。所有妊娠期的血氧饱和度中值均呈双相模式,在出生后第 1 天达到峰值,第 4 至 5 天降至最低点,第 14 天左右升至第二个峰值。低胎龄出生的婴儿在每个时间点的 FiO2 中位数都较高。胎龄越小的婴儿接受机械通气的比例越高,采用无创通气模式的时间也越晚:结论:极早产儿出生后需要补充氧气的比例呈现出一致的双相模式。
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引用次数: 0
The Pressing Issue of Food Safety for Infants and the Role of the Pediatrician 婴儿食品安全的紧迫问题和儿科医生的作用。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114088
Massimo Pettoello-Mantovani MD, PhD , Donjeta Bali MD , Maria Pastore MD , Ida Giardino MD , Leyla Namazova-Baranova MD, PhD , Georgios Konstantinidis MD , Mehmet Vural MD
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引用次数: 0
Characteristics of Fentanyl Toxicity in Very Young Children 年幼儿童的芬太尼毒性特征
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114409
Courtney Temple MD, Emma Cassidy MD, Robert G. Hendrickson MD
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.
接触非法芬太尼的儿童往往会出现严重中毒,需要反复服用纳洛酮并接受长时间的气道支持。本回顾性研究介绍了四例病例的临床过程和处理方法,强调了及时识别和干预的迫切需要,以应对非法芬太尼暴露对年幼儿童造成的长期严重影响。
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引用次数: 0
Step Up After Concussion
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2025.114467
Paul G. Fisher MD
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引用次数: 0
Information for Readers
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/S0022-3476(24)00554-7
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引用次数: 0
One of the Most Common Diseases You May Never Have Heard About
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2025.114468
Thomas R. Welch MD
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引用次数: 0
Assessing Early Severity of Hypoxic-Ischemic Encephalopathy: The Role of Electroencephalogram Background in Addition to Sarnat Exam 评估缺氧缺血性脑病的早期严重程度:脑电图背景对萨纳特检查的补充作用
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114411
Marie-Coralie Cornet MD, PhD , Adam L. Numis MD , Sarah E. Monsell MS , Natalie H. Chan MD, MPH , Fernando F. Gonzalez MD , Bryan A. Comstock MS , Sandra E. Juul MD, PhD , Courtney J. Wusthoff MD, MS , Yvonne W. Wu MD, MPH , Hannah C. Glass MDCM, MAS

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。
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引用次数: 0
Longitudinal Analysis of Amplitude-Integrated Electroencephalography for Outcome Prediction in Infants with Hypoxic-Ischemic Encephalopathy: A Validation Study 纵向分析振幅积分脑电图,预测缺氧缺血性脑病婴儿的预后:验证研究。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114407
Mathies Rondagh MD , Linda S. de Vries MD, PhD , Andrea van Steenis MD , Unoke Meder MD , Laszlo Szakacs MSc , Agnes Jermendy MD, PhD, MPI , Sylke J. Steggerda MD, PhD

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.
目的通过纵向分析振幅积分脑电图(aEEG)的背景活动和睡眠-觉醒周期(SWC)来预测接受治疗性低温(TH)的缺氧缺血性脑病(HIE)婴儿2年神经发育结局的好坏,验证之前发表的工具(HOPE计算器)的预后准确性,并评估其对5至8岁时预后的预测价值:研究设计:单中心回顾性队列研究,研究对象为 2008 年至 2022 年间因 HIE 而接受治疗性低温的 117 名婴儿。我们在 84 小时内以 6 小时间隔对双通道 aEEG 背景模式、SWC 和癫痫发作活动进行评分。使用贝利婴儿发育量表-III(BSID-III)评估了2岁时的神经发育结局,将不良结局定义为死亡、脑瘫(CP)和/或认知/运动评分:预测模型显示,2 岁时的曲线下面积为 0.90(95% CI,0.83-0.95),5-8 岁时为 0.83(95% CI,0.73-0.92)。在2年(n=115)和5至8年(n=68)时,良好预后组的平均预测良好预后概率分别为74.5%(95% CI,69.4-79.6)和32.8%(95% CI,23.5-42.2)(p< 0.001),而不良预后组的平均预测不良预后概率分别为76.85%(95% CI,70.0-83.4)和40.7%(95% CI,30.0-51.4):我们的研究为 HOPE 计算器提供了外部验证,该计算器可评估 HIE 婴儿在 TH 期间的纵向 aEEG 背景活动。结果表明,该方法不仅能准确预测2岁时的良好或不良预后,还能预测5至8岁时的良好或不良预后。
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引用次数: 0
期刊
Journal of Pediatrics
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