Journal of Pediatrics最新文献

英文中文

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

Journal of 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

Early Young Adult Death Underscores the Need for Adolescent and Young Adult Transition Programs in Neurofibromatosis Type 1 1型神经纤维瘤病(NF1)患者在成年早期死亡凸显了青少年过渡计划的必要性。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114413

Tina Tarnawsky MD , Inez Y. Oh PhD , Ethan Hillis MS , Aditi Gupta PhD , David H. Gutmann MD, PhD

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.

目前只有少数几个中心将儿童和成人神经纤维瘤病 1 的诊疗和护理过渡计划结合在一起。通过使用基于电子健康记录的方法，我们发现在患者生命的第四个十年出现了一个死亡高峰，这主要是由于恶性肿瘤引起的。

引用次数: 0

Reply to Why the Negative? A Reflective Analysis on the Impact of Weekly Vitamin D Supplementation on Acute Respiratory Infections in Young Children 回复《为什么是负面的？每周补充维生素 D 对幼儿急性呼吸道感染影响的反思性分析》。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114418

María Loreto Reyes MD, Cecilia Vizcaya MD, Catalina Le Roy MD, Carlos A. Camargo Jr MD, DrPH, Arturo Borzutzky MD

引用次数: 0

Outcomes of Patent Ductus Arteriosus Closure by Availability of Cardiac Surgeons for Infants Born Preterm

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-01-30 DOI: 10.1016/j.jpeds.2025.114492

Tomohiro Takeda MD , Tetsuya Isayama MD, MSc, PhD , Tohru Kobayashi MD, PhD , Shoichiro Amari MD , Atsushi Nakao MD , Katsuaki Toyoshima MD , Satoshi Masutani MD , PLASE (Patent Ductus Arteriosus and Left Atrial Size Evaluation in Preterm Infants) Study Group Investigators

Objective

To evaluate the treatment strategies for closure of patent ductus arteriosus (PDA) and clinical outcomes among very preterm infants based upon the availability of cardiac surgeons in neonatal intensive care units (NICUs).

Study design

This study retrospectively assessed infants born at 23-29 weeks of gestation who participated in a prior prospective cohort study in Japan. The primary outcome was PDA surgery. The secondary outcomes included mortality and various morbidities, such as intraventricular hemorrhage and chronic lung disease (CLD). Outcomes were compared between with-surgeon and no-surgeon NICUs using generalized linear mixed effect models, adjusted for gestational age, antenatal corticosteroid, small-for-gestational age, and unit patient volume.

Results

This study included 613 infants from 27 NICUs, including 245 from 9 no-surgeon NICUs and 368 from 18 with-surgeon NICUs. Infants received significantly more prophylactic indomethacin in the no-surgeon NICUs than those in the with-surgeon NICUs. The frequency of PDA surgery showed no significant difference between the groups (9.0% vs 12%, adjusted odds ratio [aOR]: 0.56 [95% confidence interval: 0.21-1.51]). CLD was significantly more frequent in no-surgeon NICUs than in with-surgeon NICUs (55% vs 40%, aOR: 3.24 [95% CI 1.45-7.29]).

Conclusions

The frequency of PDA surgery did not differ significantly according to the availability of surgeons. The incidence of CLD was higher in no-surgeon NICUs; however, the risk of unmeasured confounding cannot be excluded due to the observational study design.

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引用次数: 0

Weight Trajectories among Children with Down Syndrome: A Retrospective Study

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-01-28 DOI: 10.1016/j.jpeds.2025.114491

Haley J. Killian PhD , Bethany Forseth PhD , Dana M. Bakula PhD , Lauren Ptomey PhD , Earl Glynn MS , Hung-Wen Yeh PhD, MS , Ann M. Davis PhD, MPH , Meredith Dreyer Gillette PhD

Objectives

To evaluate body mass index trajectories over time and to evaluate common comorbidities across a large, nationally representative sample of youth with Down syndrome (DS).

Study design

This retrospective study included children ages 2-18 years within the Cerner Health Facts database with a diagnosis of DS and a medical visit between 2010 and 2017. Comorbid conditions were mapped into PheCodes (ie, ≥1 International Classification of Diseases codes that combine into specific diseases or traits) and were included if they occurred in ≥1% (145 PheCodes) of the sample.

Results

Outcomes trajectories were analyzed through generalized additive mixed models. Estimated modified body mass index z-scores showed a general trend of nonlinear increasing weight by age, specifically an increase from age 2 through 5 years, then stabilization until age 10, thereafter increasing again. When comorbidities were included, some were associated with lower rates of weight gain, whereas others were associated with higher rates of weight gain.

Conclusions

This study showed rapid weight gain in early years and early adolescence for youth with DS. This pattern of weight gain is consistent with same-age peers; however, youth with DS have difficulty recovering after these periods owing to several factors, such as not having the same height gain. Given these patterns, intervention and prevention should target periods of time when recovery is difficult.

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引用次数: 0

An mHealth Intervention to Support Psychosocial Well-Being of Racial and Ethnically Diverse Families in the Neonatal Intensive Care Unit

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-01-27 DOI: 10.1016/j.jpeds.2025.114470

Craig F. Garfield MD, MAPP , Joshua E. Santiago MA , Kathryn L. Jackson MS , Kousiki Patra MD , Jeffrey L. Loughead MD , Joel B. Fisher MD , Kathleen O'Sullivan MS , Rebecca Christie MA , Young S. Lee PhD

Objective

To assess the effectiveness of an mHealth neonatal intensive care unit (NICU) parent support smartphone application to improve psychosocial well-being, specifically reduced stress and anxiety, increased parenting competence, and improved social support among a diverse group of parents with infants born preterm in 3 Chicago-area NICUs.

Study design

A time-lapsed, quasiexperimental design in which control participants were enrolled and then intervention participants enrolled. Data collection occurred at 3 timepoints: NICU admission (AD), discharge (DC), and 30 days post-DC (DC+30). Validated outcome measures included parenting sense of competence, stress, anxiety, and social support.

Results

Intention-to-treat analyses included 400 participants (156 intervention; 244 control). After covariate adjustment, a significant increase in parenting sense of competence (AD–DC, DC+30), decrease in stress (AD–DC+30), decrease in anxiety (AD–DC, DC+30), and increase in social support (AD–DC) were noted but did not differ by study arm. However, secondary analysis of parents with infants born at <32 weeks of gestational age (156 participants) showed decrease in stress (AD–DC+30) that was greater in intervention vs control group (P = .03). Among intervention participants who were Black, a significant increase in social support (AD–DC) total score (P = .01), and 2 subscales of emotional/informational support (P = .02) and positive social interaction (P = .02) were found.

Conclusions

This novel mHealth intervention shows evidence of reduced stress and anxiety while increasing social support among some subsets of parents at high risk of negative psychosocial experiences in the NICU, potentially enhancing outcomes for infants born preterm by ensuring that parents are less stressed and better supported.

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引用次数: 0

Ethical Challenges in Pediatric Medical Complexity: A Survey of Parents

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-01-27 DOI: 10.1016/j.jpeds.2025.114478

Miriam C. Shapiro MD , Kathryn Detwiler BS , Jennifer Shepard BSN, MBA , Talia Bernhard BA , Xiaobai Li PhD , Renee D. Boss MD MHS , Vanessa N. Madrigal MD MSCE

Objective

To understand parents’ experiences of ethical challenges in the care of children with chronic and serious medical conditions and what resources they access for support.

Study design

We recruited English-speaking parents of children with complex and serious medical conditions via family advocacy groups to complete an electronic survey from October 2022 through February 2023. We queried respondents' experiences with specific ethical challenges in the care of their child, whether their concerns persisted, and what resources they accessed. Respondents also reported demographics, educational backgrounds, financial resources, and their child's medical needs.

Results

Two hundred eighteen parents completed surveys. Parents reported experiencing each of the 15 presented ethical challenges with varying frequency. More than half of parents reported residual distress in 6 of 15 ethical challenges. Demographic variables (gender, relationship status, time since medical challenge, and ethnicity) were not associated with level of distress related to ethical challenges. When facing challenges, respondents most commonly communicated with family members, friends, doctors, and other parents of children with medical problems, accessed the internet, and relied on their instincts or prayer/meditation.

Conclusions

Parents of children with medical complexity experience ethical challenges in the care of their children, although covering a broader range of experiences than typically considered by clinicians to have ethical dimensions. Many of these challenges leave residual distress. The resources that families report accessing to navigate these challenges are ones that typically do not have training, background, or specificity to medical ethics.

目的：了解父母在照顾患有慢性病和重病的儿童时遇到的伦理挑战，以及他们获得支持的资源：研究设计：研究设计：我们通过家庭维权组织招募了讲英语的患有复杂和严重病症儿童的家长，让他们在 2022 年 10 月至 2023 年 2 月期间完成一项电子调查。我们询问了受访者在照顾孩子过程中遇到特定伦理挑战的经历、他们的担忧是否持续存在以及他们获得了哪些资源。受访者还报告了人口统计学、教育背景、经济来源以及他们孩子的医疗需求。据家长们报告，他们遇到 15 项伦理挑战中的每一项挑战的频率都不尽相同。半数以上的家长表示在 6/15 项伦理挑战中仍存在困扰。人口统计学变量（性别、关系状况、医疗挑战发生时间和种族）与伦理挑战相关的困扰程度无关。面对挑战时，受访者最常与家人、朋友、医生和其他有医疗问题儿童的家长沟通，上网，以及依靠直觉或祈祷/冥想：有复杂医疗问题的儿童的家长在照顾孩子的过程中会遇到伦理方面的挑战，尽管这些挑战所涉及的范围比临床医生通常认为的伦理问题要广泛得多。这些挑战中有很多都会留下后遗症。据家庭报告，他们在应对这些挑战时所利用的资源通常没有受过医学伦理方面的培训，也没有医学伦理方面的背景或特殊性。

{"title":"Ethical Challenges in Pediatric Medical Complexity: A Survey of Parents","authors":"Miriam C. Shapiro MD , Kathryn Detwiler BS , Jennifer Shepard BSN, MBA , Talia Bernhard BA , Xiaobai Li PhD , Renee D. Boss MD MHS , Vanessa N. Madrigal MD MSCE","doi":"10.1016/j.jpeds.2025.114478","DOIUrl":"10.1016/j.jpeds.2025.114478","url":null,"abstract":"<div><h3>Objective</h3><div>To understand parents’ experiences of ethical challenges in the care of children with chronic and serious medical conditions and what resources they access for support.</div></div><div><h3>Study design</h3><div>We recruited English-speaking parents of children with complex and serious medical conditions via family advocacy groups to complete an electronic survey from October 2022 through February 2023. We queried respondents' experiences with specific ethical challenges in the care of their child, whether their concerns persisted, and what resources they accessed. Respondents also reported demographics, educational backgrounds, financial resources, and their child's medical needs.</div></div><div><h3>Results</h3><div>Two hundred eighteen parents completed surveys. Parents reported experiencing each of the 15 presented ethical challenges with varying frequency. More than half of parents reported residual distress in 6 of 15 ethical challenges. Demographic variables (gender, relationship status, time since medical challenge, and ethnicity) were not associated with level of distress related to ethical challenges. When facing challenges, respondents most commonly communicated with family members, friends, doctors, and other parents of children with medical problems, accessed the internet, and relied on their instincts or prayer/meditation.</div></div><div><h3>Conclusions</h3><div>Parents of children with medical complexity experience ethical challenges in the care of their children, although covering a broader range of experiences than typically considered by clinicians to have ethical dimensions. Many of these challenges leave residual distress. The resources that families report accessing to navigate these challenges are ones that typically do not have training, background, or specificity to medical ethics.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114478"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048805","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}

引用次数: 0

Neurodevelopmental Follow-Up in Children with Intrauterine and Perinatal Exposure to Chikungunya Virus

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-01-27 DOI: 10.1016/j.jpeds.2025.114477

Fátima Cristiane Pinho de Almeida Di Maio Ferreira MD, PhD , Karin Nielsen-Saines MD, MPH , Maria Elisabeth Lopes Moreira MD, PhD , Aline Dessimoni Salgado MD , Roozemeria Pereira Costa MS , Simone B. de Campos PhD , Dajie Zhang PhD , Britta Hüning MD , Christa Einspieler PhD , Peter B. Marschik Dphil, DMsc, PhD , Trevon Fuller PhD , Patricia Brasil MD, PhD

Objective

To investigate the effects of intrauterine and perinatal exposure to chikungunya virus (CHIKV) on neurodevelopment in infants and toddlers.

Study design

We conducted a cohort study comparing children with intrauterine or perinatal exposure to maternal CHIKV infection with unexposed controls in Rio de Janeiro, Brazil. Neurodevelopment was assessed with General Movement Assessments in the first 6 months of life, and the Bayley-III Scales of Infant and Toddler Development and Modified Checklist for Autism in Toddlers for older children. Developmental delay (DD) was defined as a Bayley score less than 70 and risk of DD as a score less than 85.

Results

Among 60 children exposed to intrauterine or perinatal CHIKV, 20 (33%) had laboratory confirmation of CHIKV infection by reverse transcription polymerase chain reaction or immunoglobulin M serology and 40 did not; 44 exposed children (15 infected and 29 uninfected) had General Movement Assessment performed, with 19% having suboptimal or abnormal results. At 11-42 months of age, 35 exposed children and 78 unexposed controls had Bayley-III assessments. Compared with controls, exposed children had higher rates of DD (7 [20%] vs 2 [3%], P = .004) driven by the language domain, and greater risk of DD driven by motor and cognitive domains scores (10 [29%] vs 10 [13%], P = .03 and 8 [23%] vs 5 [6%], P = .02, respectively). Eight of 35 (23%), CHIKV exposed children screened positive for autism spectrum disorder. CHIKV-exposed uninfected children had 2 (9.5%) cases of DD and 5 (23.8%) cases of autism spectrum disorder.

Conclusions

Abnormal neurodevelopmental results were seen in both infected and uninfected children with intrauterine or perinatal CHIKV exposure. Infant neurodevelopment monitoring should be considered following exposure to maternal CHIKV infection in pregnancy to facilitate early interventions and to mitigate neurodevelopmental sequelae.

{"title":"Neurodevelopmental Follow-Up in Children with Intrauterine and Perinatal Exposure to Chikungunya Virus","authors":"Fátima Cristiane Pinho de Almeida Di Maio Ferreira MD, PhD , Karin Nielsen-Saines MD, MPH , Maria Elisabeth Lopes Moreira MD, PhD , Aline Dessimoni Salgado MD , Roozemeria Pereira Costa MS , Simone B. de Campos PhD , Dajie Zhang PhD , Britta Hüning MD , Christa Einspieler PhD , Peter B. Marschik Dphil, DMsc, PhD , Trevon Fuller PhD , Patricia Brasil MD, PhD","doi":"10.1016/j.jpeds.2025.114477","DOIUrl":"10.1016/j.jpeds.2025.114477","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effects of intrauterine and perinatal exposure to chikungunya virus (CHIKV) on neurodevelopment in infants and toddlers.</div></div><div><h3>Study design</h3><div>We conducted a cohort study comparing children with intrauterine or perinatal exposure to maternal CHIKV infection with unexposed controls in Rio de Janeiro, Brazil. Neurodevelopment was assessed with General Movement Assessments in the first 6 months of life, and the Bayley-III Scales of Infant and Toddler Development and Modified Checklist for Autism in Toddlers for older children. Developmental delay (DD) was defined as a Bayley score less than 70 and risk of DD as a score less than 85.</div></div><div><h3>Results</h3><div>Among 60 children exposed to intrauterine or perinatal CHIKV, 20 (33%) had laboratory confirmation of CHIKV infection by reverse transcription polymerase chain reaction or immunoglobulin M serology and 40 did not; 44 exposed children (15 infected and 29 uninfected) had General Movement Assessment performed, with 19% having suboptimal or abnormal results. At 11-42 months of age, 35 exposed children and 78 unexposed controls had Bayley-III assessments. Compared with controls, exposed children had higher rates of DD (7 [20%] vs 2 [3%], <em>P</em> = .004) driven by the language domain, and greater risk of DD driven by motor and cognitive domains scores (10 [29%] vs 10 [13%], <em>P</em> = .03 and 8 [23%] vs 5 [6%], <em>P</em> = .02, respectively). Eight of 35 (23%), CHIKV exposed children screened positive for autism spectrum disorder. CHIKV-exposed uninfected children had 2 (9.5%) cases of DD and 5 (23.8%) cases of autism spectrum disorder.</div></div><div><h3>Conclusions</h3><div>Abnormal neurodevelopmental results were seen in both infected and uninfected children with intrauterine or perinatal CHIKV exposure. Infant neurodevelopment monitoring should be considered following exposure to maternal CHIKV infection in pregnancy to facilitate early interventions and to mitigate neurodevelopmental sequelae.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114477"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048821","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}

引用次数: 0

Balancing Volume and Outcomes: Insights and Cautions from a Multistate Analysis of Care for Infants Born Very Preterm.

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-01-27 DOI: 10.1016/j.jpeds.2025.114481

Siyuan Jiang, Henry C Lee

引用次数: 0

Cyclosporine Treatment in Patients with Kawasaki Disease and Coronary Artery Aneurysms or Treatment Resistance

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-01-24 DOI: 10.1016/j.jpeds.2025.114479

Irene Bellicini MD , Emelia Bainto BA , Chisato Shimizu MD , Jane C. Burns MD , Adriana H. Tremoulet MD, MAS

Objective

To describe the clinical course and outcome of 33 patients with Kawasaki disease (KD) treated with cyclosporine (CSA) for coronary artery abnormalities (CAA) or treatment resistance.

Study design

Single-center, retrospective study of patients with KD treated from 2013 through 2023 for CAA or treatment resistance. Demographics, laboratory studies, medications, adverse events, and echocardiographic data were analyzed.

Results

Of the 33 KD patients treated with CSA, 25 patients received CSA for CAA and 8 for treatment resistance. Four patients received CSA intravenously initially, followed by oral therapy. Since 2014, all patients received CSA orally only. The target 2-hour postdose level (300-600 ng/ml) was best achieved by dividing 5 mg/kg/day every 12 hours. We developed a standardized treatment protocol based on our experiences with this patient population. The patients treated for CAA all showed improved coronary artery Z-scores at both the 2-week and 6-week follow-up. Two patients experienced significant adverse events. One patient had posterior reversible encephalopathy syndrome, while the other developed Epstein-Barr virus-associated lymphoproliferative disorder. Discontinuation of CSA led to complete recovery in both cases.

Conclusions

CSA was generally well tolerated in patients with KD and CAA or treatment resistance. Our study contributes to the limited literature on CSA use in KD, providing dosing guidance and advocating for cautious monitoring.

{"title":"Cyclosporine Treatment in Patients with Kawasaki Disease and Coronary Artery Aneurysms or Treatment Resistance","authors":"Irene Bellicini MD , Emelia Bainto BA , Chisato Shimizu MD , Jane C. Burns MD , Adriana H. Tremoulet MD, MAS","doi":"10.1016/j.jpeds.2025.114479","DOIUrl":"10.1016/j.jpeds.2025.114479","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the clinical course and outcome of 33 patients with Kawasaki disease (KD) treated with cyclosporine (CSA) for coronary artery abnormalities (CAA) or treatment resistance.</div></div><div><h3>Study design</h3><div>Single-center, retrospective study of patients with KD treated from 2013 through 2023 for CAA or treatment resistance. Demographics, laboratory studies, medications, adverse events, and echocardiographic data were analyzed.</div></div><div><h3>Results</h3><div>Of the 33 KD patients treated with CSA, 25 patients received CSA for CAA and 8 for treatment resistance. Four patients received CSA intravenously initially, followed by oral therapy. Since 2014, all patients received CSA orally only. The target 2-hour postdose level (300-600 ng/ml) was best achieved by dividing 5 mg/kg/day every 12 hours. We developed a standardized treatment protocol based on our experiences with this patient population. The patients treated for CAA all showed improved coronary artery Z-scores at both the 2-week and 6-week follow-up. Two patients experienced significant adverse events. One patient had posterior reversible encephalopathy syndrome, while the other developed Epstein-Barr virus-associated lymphoproliferative disorder. Discontinuation of CSA led to complete recovery in both cases.</div></div><div><h3>Conclusions</h3><div>CSA was generally well tolerated in patients with KD and CAA or treatment resistance. Our study contributes to the limited literature on CSA use in KD, providing dosing guidance and advocating for cautious monitoring.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114479"},"PeriodicalIF":3.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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