Pub Date : 2025-12-20DOI: 10.1016/j.jpeds.2025.114969
Kurt R. Lehner MD , Anita L. Kalluri BA , Kelly Jiang MS , Rama J. Alawneh MD , Ryan P. Lee MD , Foad Kazemi MD , Joan Yea MHS , Sai Chandan Reddy BS , Jacob Shaw BS , Ann Kane MD , Eric M. Jackson MD
Objective
To create a simple scoring system to stratify likelihood of shunt failure in the emergency department.
Study design
We conducted a retrospective cohort study of all children presenting to the pediatric emergency department with concern for ventricular shunt failure from 2017 to 2022. A separate dataset from 2022 to 2023 was used for validation. The main predictors of shunt revision were determined using univariate and multivariable regression models, and a scoring system utilizing the top predictors of ventricular shunt malfunction was created.
Results
There were 1167 neurosurgical consultations for shunt malfunction during the study period which resulted in 285 shunt revisions. Utilizing the 10 variables most associated with revision (increased ventricle size, abnormal shunt series, bradycardia, lethargy, altered mental status, vomiting, headache, shorter time interval from last shunt surgery, seizure, and the presence of upper respiratory symptoms), a SMaRT score was developed. For Shunt Malfunction and Revision Triage (SMaRT) score <4, we achieved a receiver-operating characteristic area under the curve of 0.87 with sensitivity of 0.93, specificity of 0.58, positive predictive value of 0.42, and negative predictive value of 0.96. This was confirmed in a separate validation set of 119 patients. A similar analysis excluding imaging data yielded a significant decrease in the discrimination of the scoring system, dropping the receiver-operating characteristic area under the curve to 0.71.
Conclusions
The SMaRT score provides a data-driven tool to determine the utility of a neurosurgical consult for shunt malfunction with a high negative predictive value for shunt malfunction in its lowest tier. Use of this tool has the potential to improve triage and resource utilization in the emergency department.
{"title":"Predicting Failure of Ventricular Shunts in the Emergency Department: The SMaRT (Shunt Malfunction and Revision Triage) Score","authors":"Kurt R. Lehner MD , Anita L. Kalluri BA , Kelly Jiang MS , Rama J. Alawneh MD , Ryan P. Lee MD , Foad Kazemi MD , Joan Yea MHS , Sai Chandan Reddy BS , Jacob Shaw BS , Ann Kane MD , Eric M. Jackson MD","doi":"10.1016/j.jpeds.2025.114969","DOIUrl":"10.1016/j.jpeds.2025.114969","url":null,"abstract":"<div><h3>Objective</h3><div>To create a simple scoring system to stratify likelihood of shunt failure in the emergency department.</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of all children presenting to the pediatric emergency department with concern for ventricular shunt failure from 2017 to 2022. A separate dataset from 2022 to 2023 was used for validation. The main predictors of shunt revision were determined using univariate and multivariable regression models, and a scoring system utilizing the top predictors of ventricular shunt malfunction was created.</div></div><div><h3>Results</h3><div>There were 1167 neurosurgical consultations for shunt malfunction during the study period which resulted in 285 shunt revisions. Utilizing the 10 variables most associated with revision (increased ventricle size, abnormal shunt series, bradycardia, lethargy, altered mental status, vomiting, headache, shorter time interval from last shunt surgery, seizure, and the presence of upper respiratory symptoms), a SMaRT score was developed. For Shunt Malfunction and Revision Triage (SMaRT) score <4, we achieved a receiver-operating characteristic area under the curve of 0.87 with sensitivity of 0.93, specificity of 0.58, positive predictive value of 0.42, and negative predictive value of 0.96. This was confirmed in a separate validation set of 119 patients. A similar analysis excluding imaging data yielded a significant decrease in the discrimination of the scoring system, dropping the receiver-operating characteristic area under the curve to 0.71.</div></div><div><h3>Conclusions</h3><div>The SMaRT score provides a data-driven tool to determine the utility of a neurosurgical consult for shunt malfunction with a high negative predictive value for shunt malfunction in its lowest tier. Use of this tool has the potential to improve triage and resource utilization in the emergency department.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114969"},"PeriodicalIF":3.5,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812319","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 : 2025-12-17DOI: 10.1016/j.jpeds.2025.114961
Leigh Selesner MD , Madeline Hedges BS , Rachel Pung BS , Cortnie Vaughn MD , Adam Burns PhD , Molly Aloia MS , Justin Henson BS , Joseph Tobias MD, MPH , Amy Olyaei BS , Samantha Nizich BS , Kevin Swift PhD , Amirali Veshagh BS , Sarah F. Andres PhD , Elizabeth Fialkowski MD , Brian K. Jordan MD, PhD , Brian Scottoline MD, PhD
Objectives
To evaluate the incidence of necrotizing enterocolitis before probiotic introduction, during probiotic administration, and after its cessation following the 2023 US Food and Drug Administration advisory discouraging probiotic use in preterm infants.
Study design
Retrospective non-concurrent cohort study of very low birthweight (VLBW) infants (birthweight <1500 g), admitted to a level IV neonatal intensive care unit (NICU) from 2014 through 2024. Infants were grouped into three epochs based on Bifidobacterium longum ssp. infantis (B. infantis) EVC001 use: pre-EVC001 (no probiotic), EVC001 (routine use), and post-EVC001 (post-discontinuation). The primary outcome was NEC incidence. Secondary outcomes included NEC-associated mortality, all-cause mortality, NEC severity and NEC incidence among extremely low birthweight (ELBW; <1000 g) infants. Multivariable log-binomial and ordinal logistic regression models were used.
Results
Among 733 VLBW infants, NEC incidence was 12% pre-EVC001, 2.6% EVC001, and 16% post-EVC001 (P < .001). NEC risk was higher both pre-EVC001 (adjusted relative risk [aRR] 4.4, 95% confidence interval [CI] 2.2-9.0) and post-EVC001 (aRR 4.5, 95% CI 2.0-9.9; both P < .001) compared to during EVC001 administration. ELBW infants showed similar trends. EVC001 use was associated with reduced odds of severe NEC compared to epochs without EVC001 use (VLBW odds ratio 5.3, 95% CI 2.5-11.0; ELBW odds ratio 5.0, 95% CI 2.2-11.7; both P < .001). NEC-related mortality was lowest during EVC001exposed infants (0.9%) compared to unexposed (2.8, P = .05).
Conclusions
NEC rates were higher before, lower during and rose after discontinuation of EVC001 in this single center retrospective study. There is a need for multicenter trials evaluating B. infantis for NEC prevention.
{"title":"Increase in Necrotizing Enterocolitis with Cessation of Bifidobacterium longum ssp. infantis Administration in Very Low Birthweight Infants: A Single Center Retrospective Cohort Study","authors":"Leigh Selesner MD , Madeline Hedges BS , Rachel Pung BS , Cortnie Vaughn MD , Adam Burns PhD , Molly Aloia MS , Justin Henson BS , Joseph Tobias MD, MPH , Amy Olyaei BS , Samantha Nizich BS , Kevin Swift PhD , Amirali Veshagh BS , Sarah F. Andres PhD , Elizabeth Fialkowski MD , Brian K. Jordan MD, PhD , Brian Scottoline MD, PhD","doi":"10.1016/j.jpeds.2025.114961","DOIUrl":"10.1016/j.jpeds.2025.114961","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the incidence of necrotizing enterocolitis before probiotic introduction, during probiotic administration, and after its cessation following the 2023 US Food and Drug Administration advisory discouraging probiotic use in preterm infants.</div></div><div><h3>Study design</h3><div>Retrospective non-concurrent cohort study of very low birthweight (VLBW) infants (birthweight <1500 g), admitted to a level IV neonatal intensive care unit (NICU) from 2014 through 2024. Infants were grouped into three epochs based on <em>Bifidobacterium longum</em> ssp. <em>infantis</em> (<em>B</em>. <em>infantis</em>) EVC001 use: pre-EVC001 (no probiotic), EVC001 (routine use), and post-EVC001 (post-discontinuation). The primary outcome was NEC incidence. Secondary outcomes included NEC-associated mortality, all-cause mortality, NEC severity and NEC incidence among extremely low birthweight (ELBW; <1000 g) infants. Multivariable log-binomial and ordinal logistic regression models were used.</div></div><div><h3>Results</h3><div>Among 733 VLBW infants, NEC incidence was 12% pre-EVC001, 2.6% EVC001, and 16% post-EVC001 (<em>P</em> < .001). NEC risk was higher both pre-EVC001 (adjusted relative risk [aRR] 4.4, 95% confidence interval [CI] 2.2-9.0) and post-EVC001 (aRR 4.5, 95% CI 2.0-9.9; both <em>P</em> < .001) compared to during EVC001 administration. ELBW infants showed similar trends. EVC001 use was associated with reduced odds of severe NEC compared to epochs without EVC001 use (VLBW odds ratio 5.3, 95% CI 2.5-11.0; ELBW odds ratio 5.0, 95% CI 2.2-11.7; both <em>P</em> < .001). NEC-related mortality was lowest during EVC001exposed infants (0.9%) compared to unexposed (2.8, <em>P</em> = .05).</div></div><div><h3>Conclusions</h3><div>NEC rates were higher before, lower during and rose after discontinuation of EVC001 in this single center retrospective study. There is a need for multicenter trials evaluating <em>B</em>. <em>infantis</em> for NEC prevention.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"291 ","pages":"Article 114961"},"PeriodicalIF":3.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795296","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 : 2025-12-17DOI: 10.1016/j.jpeds.2025.114962
Natasha Amery BSc , Caroline F. Alexander PhD , Alison T. Salt MSc , Sarah E. Hall PhD , Catherine Elliott PhD , Catherine Morgan PhD , Alicia J. Spittle PhD , Jane Valentine PhD
Objectives
To describe writhing General Movements Assessment (GMA) classification and General Movement Optimality Score–Revised (GMOS-R) profiles in the general population; to explore relationships between GMOS-R scores and GMA classification, age of assessment and infant socio-demographic factors; and to establish the inter-rater reproducibility of writhing age GMA classification and GMOS-R.
Study design
A cross-sectional study of 1861 infants recruited from the general population in Perth, Western Australia, including 7.5% born preterm. Parent-recorded videos were collected between 41- and 45-weeks post-menstural age, when writhing movements are typically observed. General movements (GMs) classification and GMOS-R were assessed independently by at least 2 experienced advanced-trained clinicians.
Results
The majority of infants' GMs were classified as normal (66.8%) or poor repertoire (33.2%), with one infant's movements classified as cramped synchronized (0.1%). The median GMOS-R score was 33 (interquartile range 27-36). The GMOS-R differentiated GMA classifications. Lower gestational age, any nursery admission, minority ethnicity, and older age at video collection were each associated with a small but statistically significant reduction in GMOS-R scores. GMA classification had excellent inter-rater reliability and agreement. Total GMOS-R had excellent inter-rater reliability and moderate agreement.
Conclusions
Although most infants had normal GMs there was a high prevalence of poor repertoire GMs in the general population. GMOS-R scores effectively differentiated movement quality within the poor repertoire classification. This study provides population-based percentile ranks for interpreting individual post-term GM assessments and as a reference for future research.
{"title":"General Movement Optimality Score-Revised (GMOS-R) with General Population-Based Percentile Ranks","authors":"Natasha Amery BSc , Caroline F. Alexander PhD , Alison T. Salt MSc , Sarah E. Hall PhD , Catherine Elliott PhD , Catherine Morgan PhD , Alicia J. Spittle PhD , Jane Valentine PhD","doi":"10.1016/j.jpeds.2025.114962","DOIUrl":"10.1016/j.jpeds.2025.114962","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe writhing General Movements Assessment (GMA) classification and General Movement Optimality Score–Revised (GMOS-R) profiles in the general population; to explore relationships between GMOS-R scores and GMA classification, age of assessment and infant socio-demographic factors; and to establish the inter-rater reproducibility of writhing age GMA classification and GMOS-R.</div></div><div><h3>Study design</h3><div>A cross-sectional study of 1861 infants recruited from the general population in Perth, Western Australia, including 7.5% born preterm. Parent-recorded videos were collected between 41- and 45-weeks post-menstural age, when writhing movements are typically observed. General movements (GMs) classification and GMOS-R were assessed independently by at least 2 experienced advanced-trained clinicians.</div></div><div><h3>Results</h3><div>The majority of infants' GMs were classified as normal (66.8%) or poor repertoire (33.2%), with one infant's movements classified as cramped synchronized (0.1%). The median GMOS-R score was 33 (interquartile range 27-36). The GMOS-R differentiated GMA classifications. Lower gestational age, any nursery admission, minority ethnicity, and older age at video collection were each associated with a small but statistically significant reduction in GMOS-R scores. GMA classification had excellent inter-rater reliability and agreement. Total GMOS-R had excellent inter-rater reliability and moderate agreement.</div></div><div><h3>Conclusions</h3><div>Although most infants had normal GMs there was a high prevalence of poor repertoire GMs in the general population. GMOS-R scores effectively differentiated movement quality within the poor repertoire classification. This study provides population-based percentile ranks for interpreting individual post-term GM assessments and as a reference for future research.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"291 ","pages":"Article 114962"},"PeriodicalIF":3.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795327","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 : 2025-12-17DOI: 10.1016/j.jpeds.2025.114959
Nadine Pointner MSc , Daniel Savran MD , Johannes Mader MSc , Philipp Steinbauer MD , Angelika Berger MD , Renate Fuiko PhD , David Steyrl PhD , Vito Giordano PhD
Objective
To evaluate neonatal risk factors and the predictive value of prior assessments for language development at age 3 in toddlers born before 32 weeks of gestation.
Study design
Data were acquired retrospectively from infants’ hospitalizations (level 3 perinatal center, Medical University of Vienna) and annual assessments (Bayley Scales of Infant and Toddler Development). We included children born in 2012-2020 at < 32 weeks of gestation, with annual follow-ups, at least one German-speaking parent, and unimpaired hearing. Predictors of 3-year language development were analyzed using Gradient Boost Decision Trees and interpreted through SHapely Additive exPlanations (SHAP) values.
Results
The cohort comprised 476 children (202 [42.4%] females; mean [standard deviation] gestational age, 27.4 [2.0] weeks). Risk factors were multilingualism (mean|SHAP| = 3.93, P ≤ .001), lower maternal education (mean|SHAP| = 2.51, P ≤ .001), reduced birth weight (mean|SHAP| = 1.92, P = .003), shorter gestational age (mean|SHAP| = 1.64, P = .009), grade of intraventricular hemorrhage in the left hemisphere (mean|SHAP| = 1.07, P = .005), severe intraventricular hemorrhage (mean|SHAP| = 0.80, P = .011, surgical necrotizing enterocolitis (mean|SHAP| = 0.80, P = .018), and surgical retinopathy of prematurity (mean|SHAP| = 0.59, P = .045).
Conclusions
The identification of SHAP values allowed us to evaluate the additive effect of neonatal and sociodemographic risk factors predicting language impairments in this cohort of children born preterm. Replication in other cohorts will be important, but SHAP-based analyses may be useful for tailored monitoring and implementation of early language support.
目的：评价孕前32周出生的3岁幼儿的新生儿危险因素及语言发育预估的预测价值。研究设计：回顾性数据来自婴儿住院（维也纳医科大学3级围产期中心）和年度评估（Bayley婴幼儿发育量表）。我们纳入了2012-2020年出生的儿童，结果：该队列包括476名儿童（202名[42.4%]女性；平均[SD]胎龄，27.4[2.0]周）。危险因素为多语（平均|SHAP| = 3.93, P≤0.001）、母亲受教育程度较低（平均|SHAP| = 2.51, P≤0.001）、出生体重降低（平均|SHAP| = 1.92, P = 0.003）、胎龄较短（平均|SHAP| = 1.64, P = 0.009）、左半球脑室内出血（平均|SHAP| = 1.07, P = 0.005）、重度IVH（平均|SHAP| = 0.80, P = 0.011）、外科坏血性小肠结肠炎（平均|SHAP| = 0.80, P = 0.009）、新生儿脑室内出血（平均|SHAP| = 0.80, P = 0.009）。P = 0.018)和手术性早产儿视网膜病变（ROP）（平均| = 0.59,P = 0.045）。结论：SHAP值的确定使我们能够评估新生儿和社会经济风险因素预测早产儿童语言障碍的叠加效应。在其他队列中的复制也很重要，但SHAP分析可能对量身定制的监测和早期语言支持的实施有用。
{"title":"Prediction of Language Development in Neonates Born at Less than 32 Weeks of Gestation","authors":"Nadine Pointner MSc , Daniel Savran MD , Johannes Mader MSc , Philipp Steinbauer MD , Angelika Berger MD , Renate Fuiko PhD , David Steyrl PhD , Vito Giordano PhD","doi":"10.1016/j.jpeds.2025.114959","DOIUrl":"10.1016/j.jpeds.2025.114959","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate neonatal risk factors and the predictive value of prior assessments for language development at age 3 in toddlers born before 32 weeks of gestation.</div></div><div><h3>Study design</h3><div>Data were acquired retrospectively from infants’ hospitalizations (level 3 perinatal center, Medical University of Vienna) and annual assessments (Bayley Scales of Infant and Toddler Development). We included children born in 2012-2020 at < 32 weeks of gestation, with annual follow-ups, at least one German-speaking parent, and unimpaired hearing. Predictors of 3-year language development were analyzed using Gradient Boost Decision Trees and interpreted through SHapely Additive exPlanations (SHAP) values.</div></div><div><h3>Results</h3><div>The cohort comprised 476 children (202 [42.4%] females; mean [standard deviation] gestational age, 27.4 [2.0] weeks). Risk factors were multilingualism (mean|SHAP| = 3.93, <em>P</em> ≤ .001), lower maternal education (mean|SHAP| = 2.51, <em>P</em> ≤ .001), reduced birth weight (mean|SHAP| = 1.92, <em>P</em> = .003), shorter gestational age (mean|SHAP| = 1.64, <em>P</em> = .009), grade of intraventricular hemorrhage in the left hemisphere (mean|SHAP| = 1.07, <em>P</em> = .005), severe intraventricular hemorrhage (mean|SHAP| = 0.80, <em>P</em> = .011, surgical necrotizing enterocolitis (mean|SHAP| = 0.80, <em>P</em> = .018), and surgical retinopathy of prematurity (mean|SHAP| = 0.59, <em>P</em> = .045).</div></div><div><h3>Conclusions</h3><div>The identification of SHAP values allowed us to evaluate the additive effect of neonatal and sociodemographic risk factors predicting language impairments in this cohort of children born preterm. Replication in other cohorts will be important, but SHAP-based analyses may be useful for tailored monitoring and implementation of early language support.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114959"},"PeriodicalIF":3.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795340","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 : 2025-12-16DOI: 10.1016/j.jpeds.2025.114945
Michael J Rivkin, Alexandra Linds, Mahmoud Slim, Ann-Marie Surmava, Lauren A Beslow, Michael M Dowling, Mark Mackay, Adam Kirton, Lori C Jordan, Christine K Fox, Ryan Felling, Nomazulu Dlamini, Tim Bernard, Catherine Amlie-Lefond, Gabrielle deVeber
Objective: To determine if children enrolled in the International Pediatric Stroke Study (IPSS) database (4,294 patients enrolled, 2003-2014, neonates through 18 years of age) demonstrate demographic, clinical, radiographic, and therapeutic characteristics that relate to age and development at the time of stroke .
Study design: Participants with arterial ischemic stroke or cerebral sinus venous thrombosis were enrolled using standardized consent and case report forms. Data were entered on-site and electronically transferred to a central data storage site in Toronto, Canada. Children were stratified into 4 age groups for analysis of developmental features: neonates (0-28 days of age); infants (29 days to <2 years of age); young children (2 years to <10 years old), and adolescents (> 10 years to <18 years old). Continuous and categorical variables were examined using appropriate statistical techniques in SAS.
Results: 3,809 children were analyzed: 1,112 (29.2%) neonates, 728 (19.1%) infants, 1,088 (28.6%) young children, and 881 (23.1%) adolescents. Arterial ischemic stroke alone occurred in 3,201 (916 neonates; 2,285 older children) and cerebral sinovenous thrombosis alone occurred in 608 (196 neonates; 412 older children). Age group specific clinical and neuroimaging features that segregate by ischemic stroke type were identified and are reported.
Conclusions: The IPSS database comprises the a very large, structured pediatric stroke database used by investigators to advance the understanding and treatment of pediatric stroke. Developmentally based analyses of IPSS data reveal features of childhood stroke that segregate by ischemic stroke type and age at stroke occurrence. These features should aid in understanding age-related pathophysiology and in clinical stroke recognition.
{"title":"The International Pediatric Stroke Study: Insight into Childhood Stroke from a Developmental Perspective.","authors":"Michael J Rivkin, Alexandra Linds, Mahmoud Slim, Ann-Marie Surmava, Lauren A Beslow, Michael M Dowling, Mark Mackay, Adam Kirton, Lori C Jordan, Christine K Fox, Ryan Felling, Nomazulu Dlamini, Tim Bernard, Catherine Amlie-Lefond, Gabrielle deVeber","doi":"10.1016/j.jpeds.2025.114945","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114945","url":null,"abstract":"<p><strong>Objective: </strong>To determine if children enrolled in the International Pediatric Stroke Study (IPSS) database (4,294 patients enrolled, 2003-2014, neonates through 18 years of age) demonstrate demographic, clinical, radiographic, and therapeutic characteristics that relate to age and development at the time of stroke .</p><p><strong>Study design: </strong>Participants with arterial ischemic stroke or cerebral sinus venous thrombosis were enrolled using standardized consent and case report forms. Data were entered on-site and electronically transferred to a central data storage site in Toronto, Canada. Children were stratified into 4 age groups for analysis of developmental features: neonates (0-28 days of age); infants (29 days to <2 years of age); young children (2 years to <10 years old), and adolescents (> 10 years to <18 years old). Continuous and categorical variables were examined using appropriate statistical techniques in SAS.</p><p><strong>Results: </strong>3,809 children were analyzed: 1,112 (29.2%) neonates, 728 (19.1%) infants, 1,088 (28.6%) young children, and 881 (23.1%) adolescents. Arterial ischemic stroke alone occurred in 3,201 (916 neonates; 2,285 older children) and cerebral sinovenous thrombosis alone occurred in 608 (196 neonates; 412 older children). Age group specific clinical and neuroimaging features that segregate by ischemic stroke type were identified and are reported.</p><p><strong>Conclusions: </strong>The IPSS database comprises the a very large, structured pediatric stroke database used by investigators to advance the understanding and treatment of pediatric stroke. Developmentally based analyses of IPSS data reveal features of childhood stroke that segregate by ischemic stroke type and age at stroke occurrence. These features should aid in understanding age-related pathophysiology and in clinical stroke recognition.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114945"},"PeriodicalIF":3.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783823","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 : 2025-12-15DOI: 10.1016/j.jpeds.2025.114943
Paula M. Magee MD, MPH , Erin Paquette MD, JD, MBe , Latasha A. Daniels MA, MSW , L. Nelson Sanchez-Pinto MD, MBI, FAMIA , Nadir Yehya MD, MSCE
Objective
To explore potential associations between neighborhood-level factors and early organ dysfunction in children who are critically ill.
Study design
This retrospective, ecological cohort study assessed the association between neighborhood factors and early organ dysfunction in 8289 encounters for children who were critically ill from January 2013 to December 2019 at a quaternary pediatric hospital in an urban setting. The exposures were neighborhood factors, which were measured using 3 composite indices: Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Neighborhood Disorder Index (NDI). Peak Pediatric Logistic Organ Dysfunction [PELOD]-2 scores in the first 72 hours measured early organ dysfunction as the primary outcome. An adjusted Poisson regression with robust modeling was used to measure the association.
Results
Most encounters were for patients from very low opportunity (28%), very high vulnerability (29%), and very high physical disorder neighborhoods (27%). Median peak PELOD-2 score was 3 (interquartile range 2-5). No association was identified for COI or NDI with peak PELOD-2 scores; however, there was an association between a very high SVI and greater peak PELOD-2 scores (P = .004).
Conclusions
No association was found among COI or NDI with worse early organ dysfunction. Very high SVI was associated with worse early organ dysfunction. Further studies should assess whether specific aspects of neighborhoods drive critical illness in organ-specific diseases.
{"title":"The Association Between Neighborhood Factors and Early Organ Dysfunction in Children Who Are Critically Ill: A Retrospective Cohort Study","authors":"Paula M. Magee MD, MPH , Erin Paquette MD, JD, MBe , Latasha A. Daniels MA, MSW , L. Nelson Sanchez-Pinto MD, MBI, FAMIA , Nadir Yehya MD, MSCE","doi":"10.1016/j.jpeds.2025.114943","DOIUrl":"10.1016/j.jpeds.2025.114943","url":null,"abstract":"<div><h3>Objective</h3><div>To explore potential associations between neighborhood-level factors and early organ dysfunction in children who are critically ill.</div></div><div><h3>Study design</h3><div>This retrospective, ecological cohort study assessed the association between neighborhood factors and early organ dysfunction in 8289 encounters for children who were critically ill from January 2013 to December 2019 at a quaternary pediatric hospital in an urban setting. The exposures were neighborhood factors, which were measured using 3 composite indices: Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Neighborhood Disorder Index (NDI). Peak Pediatric Logistic Organ Dysfunction [PELOD]-2 scores in the first 72 hours measured early organ dysfunction as the primary outcome. An adjusted Poisson regression with robust modeling was used to measure the association.</div></div><div><h3>Results</h3><div>Most encounters were for patients from very low opportunity (28%), very high vulnerability (29%), and very high physical disorder neighborhoods (27%). Median peak PELOD-2 score was 3 (interquartile range 2-5). No association was identified for COI or NDI with peak PELOD-2 scores; however, there was an association between a very high SVI and greater peak PELOD-2 scores (<em>P</em> = .004).</div></div><div><h3>Conclusions</h3><div>No association was found among COI or NDI with worse early organ dysfunction. Very high SVI was associated with worse early organ dysfunction. Further studies should assess whether specific aspects of neighborhoods drive critical illness in organ-specific diseases.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114943"},"PeriodicalIF":3.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776758","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 : 2025-12-13DOI: 10.1016/j.jpeds.2025.114954
Tessa de Baat MD , Moniek van de Loo MD , Cornelieke S.H. Aarnoudse-Moens PhD , Nienke M. Halbmeijer MD, PhD , Wes Onland MD, PhD , Anton H. van Kaam MD, PhD , Corine Koopman MD, PhD , Renate M.C. Swarte MD, PhD , Susanne M. Mulder-de Tollenaer MD, PhD , Margriet van Stuijvenberg MD, PhD , Ratna N.G.B. Tan MD , Ellen de Kort MD, PhD , Els Bruneel MD, PhD , Filip Cools MD, PhD , Katerina Steiner MD , Anne Debeer MD, PhD , Karen Van Mechelen MD , Henry Blom MD , Yoann Maréchal MD, PhD , Katleen Plaskie MD , E. Cavatorta MD
Objective
To examine neurodevelopmental outcomes at 5.5 years of corrected age in children included in the Systemic hydrocortisone (HC) To Prevent Bronchopulmonary Dysplasia in preterm infants (SToP-BPD) study, and to investigate the neurodevelopmental outcomes and mortality with HC treatment started between 7 and 14 days after birth compared with placebo in infants born preterm who required mechanical ventilation.
Study design
Data at 5.5 years of corrected age on cognitive, motor and neurosensory functioning, behavior, schooling, and general health outcomes were derived from regular follow-up visits. The primary outcome was death or moderate-severe neurodevelopmental impairment (NDI, complete case analysis), with NDI defined as a disability in at least 1 of the domains of cognition, motor development, vision, or hearing. Other outcomes included neurologic and behavioral assessments as well as parent reports of service use and school function.
Results
NDI was assessed in 213 of the 277 (77%) surviving children. Children attending follow-up were more likely to have highly educated or nonsmoking parents and had better neurodevelopmental outcomes at 2 years of corrected age than nonattending children. Baseline characteristics of assessed children were comparable between treatment arms. No significant difference was found on the primary outcome (OR 0.75; 95% CI 0.49-1.14; P = .18). All developmental outcomes were comparable between the HC and placebo group.
Conclusions
Treatment with HC started between 7 and 14 days after birth in infants born preterm at risk of BPD did not affect death or moderate-severe NDI nor any of the separate developmental outcome measures at 5.5 years of corrected age.
{"title":"Effect of Systemic Hydrocortisone in Ventilated Infants Born Preterm: Mortality and 5.5-Year Neurodevelopmental Outcomes of a Randomized Clinical Trial","authors":"Tessa de Baat MD , Moniek van de Loo MD , Cornelieke S.H. Aarnoudse-Moens PhD , Nienke M. Halbmeijer MD, PhD , Wes Onland MD, PhD , Anton H. van Kaam MD, PhD , Corine Koopman MD, PhD , Renate M.C. Swarte MD, PhD , Susanne M. Mulder-de Tollenaer MD, PhD , Margriet van Stuijvenberg MD, PhD , Ratna N.G.B. Tan MD , Ellen de Kort MD, PhD , Els Bruneel MD, PhD , Filip Cools MD, PhD , Katerina Steiner MD , Anne Debeer MD, PhD , Karen Van Mechelen MD , Henry Blom MD , Yoann Maréchal MD, PhD , Katleen Plaskie MD , E. Cavatorta MD","doi":"10.1016/j.jpeds.2025.114954","DOIUrl":"10.1016/j.jpeds.2025.114954","url":null,"abstract":"<div><h3>Objective</h3><div>To examine neurodevelopmental outcomes at 5.5 years of corrected age in children included in the Systemic hydrocortisone (HC) To Prevent Bronchopulmonary Dysplasia in preterm infants (SToP-BPD) study, and to investigate the neurodevelopmental outcomes and mortality with HC treatment started between 7 and 14 days after birth compared with placebo in infants born preterm who required mechanical ventilation.</div></div><div><h3>Study design</h3><div>Data at 5.5 years of corrected age on cognitive, motor and neurosensory functioning, behavior, schooling, and general health outcomes were derived from regular follow-up visits. The primary outcome was death or moderate-severe neurodevelopmental impairment (NDI, complete case analysis), with NDI defined as a disability in at least 1 of the domains of cognition, motor development, vision, or hearing. Other outcomes included neurologic and behavioral assessments as well as parent reports of service use and school function.</div></div><div><h3>Results</h3><div>NDI was assessed in 213 of the 277 (77%) surviving children. Children attending follow-up were more likely to have highly educated or nonsmoking parents and had better neurodevelopmental outcomes at 2 years of corrected age than nonattending children. Baseline characteristics of assessed children were comparable between treatment arms. No significant difference was found on the primary outcome (OR 0.75; 95% CI 0.49-1.14; <em>P</em> = .18). All developmental outcomes were comparable between the HC and placebo group.</div></div><div><h3>Conclusions</h3><div>Treatment with HC started between 7 and 14 days after birth in infants born preterm at risk of BPD did not affect death or moderate-severe NDI nor any of the separate developmental outcome measures at 5.5 years of corrected age.</div></div><div><h3>Trial registration</h3><div>2010-023777-19; <span><span>https://www.clinicaltrialsregister.eu</span><svg><path></path></svg></span></div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114954"},"PeriodicalIF":3.5,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758313","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 : 2025-12-13DOI: 10.1016/j.jpeds.2025.114956
Maria Heyman MD , Helena Grönqvist MSc, PhD , Lena Hellström-Westas MD, PhD , Fredrik Serenius MD, PhD , Ourania Vasileiadou MD , Fredrik Ahlsson MD, PhD , Ylva Fredriksson Kaul MSc, PhD , Barbro Diderholm MD, PhD
Objective
To investigate the physical and mental health of a national cohort of Swedish adults born with extremely low birth weight (ELBW, ≤1000 g) and its impact on self-reported health-related quality of life (HRQoL).
Study design
This prospective, follow-up study was conducted on a Swedish national cohort of individuals born between 1990 and 1992 with a birth weight of ≤1000 g (n = 201), along with a matched control group (n = 327) born appropriate for gestational age at term. All participants were between 26 and 29 years old at the time of the study. Data were collected through web-based questionnaires assessing physical and mental health, including the 36-item Short Form Health Survey version 2 to evaluate HRQoL. In addition, registered diagnoses were obtained from the Swedish National Board of Health and Welfare. Multivariable linear regressions were performed to investigate factors associated with HRQoL.
Results
Compared with the control group, adult individuals born ELBW had a significantly higher prevalence of physical morbidities. In terms of mental health, developmental and psychiatric conditions were also more prevalent, with the exception of mood disorders. However, there were no significant differences in self-reported HRQoL between ELBW and the control group.
Conclusions
Despite a higher prevalence of impairments, ELBW individuals may not perceive themselves as limited in their daily functioning.
{"title":"The Impact of Prematurity on Self-Reported Quality of Life in Adulthood: A Prospective Swedish National Cohort Study of Infants Born with Extremely Low Birth Weight","authors":"Maria Heyman MD , Helena Grönqvist MSc, PhD , Lena Hellström-Westas MD, PhD , Fredrik Serenius MD, PhD , Ourania Vasileiadou MD , Fredrik Ahlsson MD, PhD , Ylva Fredriksson Kaul MSc, PhD , Barbro Diderholm MD, PhD","doi":"10.1016/j.jpeds.2025.114956","DOIUrl":"10.1016/j.jpeds.2025.114956","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the physical and mental health of a national cohort of Swedish adults born with extremely low birth weight (ELBW, ≤1000 g) and its impact on self-reported health-related quality of life (HRQoL).</div></div><div><h3>Study design</h3><div>This prospective, follow-up study was conducted on a Swedish national cohort of individuals born between 1990 and 1992 with a birth weight of ≤1000 g (n = 201), along with a matched control group (n = 327) born appropriate for gestational age at term. All participants were between 26 and 29 years old at the time of the study. Data were collected through web-based questionnaires assessing physical and mental health, including the 36-item Short Form Health Survey version 2 to evaluate HRQoL. In addition, registered diagnoses were obtained from the Swedish National Board of Health and Welfare. Multivariable linear regressions were performed to investigate factors associated with HRQoL.</div></div><div><h3>Results</h3><div>Compared with the control group, adult individuals born ELBW had a significantly higher prevalence of physical morbidities. In terms of mental health, developmental and psychiatric conditions were also more prevalent, with the exception of mood disorders. However, there were no significant differences in self-reported HRQoL between ELBW and the control group.</div></div><div><h3>Conclusions</h3><div>Despite a higher prevalence of impairments, ELBW individuals may not perceive themselves as limited in their daily functioning.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114956"},"PeriodicalIF":3.5,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758335","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 : 2025-12-13DOI: 10.1016/j.jpeds.2025.114941
Jenny W. Sun PhD , Daniel B. Horton MD, MSCE , Timothy J. Savage MD, MPH, MSc , Mehmet Burcu PhD , Sonia Hernandez-Diaz MD, DrPH
{"title":"Application of the Target Trial Emulation Framework to Studies in the Pediatric Population","authors":"Jenny W. Sun PhD , Daniel B. Horton MD, MSCE , Timothy J. Savage MD, MPH, MSc , Mehmet Burcu PhD , Sonia Hernandez-Diaz MD, DrPH","doi":"10.1016/j.jpeds.2025.114941","DOIUrl":"10.1016/j.jpeds.2025.114941","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"291 ","pages":"Article 114941"},"PeriodicalIF":3.5,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758328","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}
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