Pub Date : 2025-12-23DOI: 10.1016/j.jpeds.2025.114960
Peter M. Socha BSc , Jennifer A. Hutcheon PhD , Erin C. Strumpf PhD , Jessica Liauw MD, MHSc , Myriam Srour MD, PhD , Joseph Y. Ting MD, MPH , M. Amanda Skoll MD , Sam Harper PhD
Objective
To use a natural experiment to investigate the effect of antenatal corticosteroids on the risk of cerebral palsy.
Study design
We included singleton livebirths with a maternal admission for delivery from 31 + 0 through 36 + 6 weeks of gestation, in British Columbia, Canada, between 2000 and 2015. Guidelines recommended antenatal corticosteroids through 33 + 6 weeks, and we estimated the effect of the corresponding sharp drop in the proportion treated at 34 + 0 weeks on the risk of a composite of death before age 2 or cerebral palsy. We defined cerebral palsy using diagnostic codes in hospital and physician-billing records before age 5 years and corrected for misclassification using external estimates of the sensitivity and specificity. We used logistic regression to estimate marginal effects at 34 + 0 weeks.
Results
There were 20 009 children in our study sample. The crude and misclassification-corrected risks of cerebral palsy were 6.2 and 5.6 per 1000, respectively. The risk of death before age 2 or cerebral palsy declined with increasing gestational age at maternal admission for delivery, but we found no convincing evidence of an abrupt change just before vs just after 34 + 0 weeks (risk ratio: 0.98, 95% confidence interval: 0.50 to 1.98). Results were similar using a composite outcome of in-hospital newborn death or cerebral palsy, and using cerebral palsy alone.
Conclusions
We did not find evidence that the lower likelihood of being treated with antenatal corticosteroid at 34 + 0 weeks affected the risk of cerebral palsy, but the estimates were imprecise and compatible with benefits or harms.
{"title":"Antenatal Corticosteroids and Risk of Cerebral Palsy: A Regression Discontinuity Study","authors":"Peter M. Socha BSc , Jennifer A. Hutcheon PhD , Erin C. Strumpf PhD , Jessica Liauw MD, MHSc , Myriam Srour MD, PhD , Joseph Y. Ting MD, MPH , M. Amanda Skoll MD , Sam Harper PhD","doi":"10.1016/j.jpeds.2025.114960","DOIUrl":"10.1016/j.jpeds.2025.114960","url":null,"abstract":"<div><h3>Objective</h3><div>To use a natural experiment to investigate the effect of antenatal corticosteroids on the risk of cerebral palsy.</div></div><div><h3>Study design</h3><div>We included singleton livebirths with a maternal admission for delivery from 31 + 0 through 36 + 6 weeks of gestation, in British Columbia, Canada, between 2000 and 2015. Guidelines recommended antenatal corticosteroids through 33 + 6 weeks, and we estimated the effect of the corresponding sharp drop in the proportion treated at 34 + 0 weeks on the risk of a composite of death before age 2 or cerebral palsy. We defined cerebral palsy using diagnostic codes in hospital and physician-billing records before age 5 years and corrected for misclassification using external estimates of the sensitivity and specificity. We used logistic regression to estimate marginal effects at 34 + 0 weeks.</div></div><div><h3>Results</h3><div>There were 20 009 children in our study sample. The crude and misclassification-corrected risks of cerebral palsy were 6.2 and 5.6 per 1000, respectively. The risk of death before age 2 or cerebral palsy declined with increasing gestational age at maternal admission for delivery, but we found no convincing evidence of an abrupt change just before vs just after 34 + 0 weeks (risk ratio: 0.98, 95% confidence interval: 0.50 to 1.98). Results were similar using a composite outcome of in-hospital newborn death or cerebral palsy, and using cerebral palsy alone.</div></div><div><h3>Conclusions</h3><div>We did not find evidence that the lower likelihood of being treated with antenatal corticosteroid at 34 + 0 weeks affected the risk of cerebral palsy, but the estimates were imprecise and compatible with benefits or harms.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114960"},"PeriodicalIF":3.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835337","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 : 2025-12-22DOI: 10.1016/j.jpeds.2025.114968
Daniel M. Cohen MD , Sara Helwig MS , Naveen Poonai MD , Rakesh D. Mistry MD, MS , Santiago Mintegi MD, PhD , Simon Craig MBBS, PhD , Damian Roland MD, PhD , Itai Shavit MD , the Pediatric Emergency Research Networks (PERN) PAINT Study Group
Objective
To compare discharge strategies following successful ileocolic intussusception (ICI) reduction: inpatient hospitalization vs emergency department (ED) observation/discharge.
Study design
This was a planned secondary analysis of children ages 4 months to 4 years with successful ICI from 86 pediatric centers in 14 countries between January 1, 2017 and December 31, 2019. We evaluated associations between discharge strategy for outpatient recurrent ICI (re-ICI). The primary outcome was ED return for re-ICI <48 hours and the secondary within the study period.
Results
We analyzed 2686 cases of ICI; 1588 (59%) admitted to hospital and 1098 (41%) discharged from ED with median (IQR) age of 18 (9, 28) months. During the study period 238 (8.9%) returned to the ED for ICI; 10.2% (112/1098) were discharged from the ED and 7.9% (126/1588) after inpatient hospitalization. Among these 238 patients, 66 (2.5%) returned <48 h most of whom had been discharged directly from the ED with a higher odds of a return visit <48 hours compared with those admitted (odds ratio [OR] = 4.27, CI = 2.50, 7.68; adjusted OR = 3.43, CI = 1.72, 7.29), and increased odds of returning within the study period (OR = 1.32, 95% CI 1.01, 1.72; adjusted OR = 1.48, 95% CI 1.03, 2.13). Upon return, the ICI re-reduction success rate was equally high in each group, ranging from 83.9% to 94.1%.
Conclusions
Few children return to the ED with outpatient recurrent ICI, following successful reduction. Although the odds of return <48 hours due to re-ICI appear higher among patients discharged from the ED vs hospitalized, both groups have equally high rates of successful re-reduction. These findings suggest that clinicians should holistically weigh the risks and benefits, taking individual circumstances into account, to help reduce unnecessary hospitalizations.
{"title":"Discharge Strategies Following Successful Ileocolic Intussusception Reduction: Hospitalization vs Emergency Department Observation","authors":"Daniel M. Cohen MD , Sara Helwig MS , Naveen Poonai MD , Rakesh D. Mistry MD, MS , Santiago Mintegi MD, PhD , Simon Craig MBBS, PhD , Damian Roland MD, PhD , Itai Shavit MD , the Pediatric Emergency Research Networks (PERN) PAINT Study Group","doi":"10.1016/j.jpeds.2025.114968","DOIUrl":"10.1016/j.jpeds.2025.114968","url":null,"abstract":"<div><h3>Objective</h3><div>To compare discharge strategies following successful ileocolic intussusception (ICI) reduction: inpatient hospitalization vs emergency department (ED) observation/discharge.</div></div><div><h3>Study design</h3><div>This was a planned secondary analysis of children ages 4 months to 4 years with successful ICI from 86 pediatric centers in 14 countries between January 1, 2017 and December 31, 2019. We evaluated associations between discharge strategy for outpatient recurrent ICI (re-ICI). The primary outcome was ED return for re-ICI <48 hours and the secondary within the study period.</div></div><div><h3>Results</h3><div>We analyzed 2686 cases of ICI; 1588 (59%) admitted to hospital and 1098 (41%) discharged from ED with median (IQR) age of 18 (9, 28) months. During the study period 238 (8.9%) returned to the ED for ICI; 10.2% (112/1098) were discharged from the ED and 7.9% (126/1588) after inpatient hospitalization. Among these 238 patients, 66 (2.5%) returned <48 h most of whom had been discharged directly from the ED with a higher odds of a return visit <48 hours compared with those admitted (odds ratio [OR] = 4.27, CI = 2.50, 7.68; adjusted OR = 3.43, CI = 1.72, 7.29), and increased odds of returning within the study period (OR = 1.32, 95% CI 1.01, 1.72; adjusted OR = 1.48, 95% CI 1.03, 2.13). Upon return, the ICI re-reduction success rate was equally high in each group, ranging from 83.9% to 94.1%.</div></div><div><h3>Conclusions</h3><div>Few children return to the ED with outpatient recurrent ICI, following successful reduction. Although the odds of return <48 hours due to re-ICI appear higher among patients discharged from the ED vs hospitalized, both groups have equally high rates of successful re-reduction. These findings suggest that clinicians should holistically weigh the risks and benefits, taking individual circumstances into account, to help reduce unnecessary hospitalizations.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"291 ","pages":"Article 114968"},"PeriodicalIF":3.5,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829119","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 : 2025-12-22DOI: 10.1016/j.jpeds.2025.114965
Amy A. Hobson DO , Daniel Dagle BS , Craig G. Rusin PhD , Christopher J. Rhee MD, MS , Sebastian I. Acosta PhD , Patrick J. McNamara MB, BCH , Danielle R. Rios MD, MS
Objective
To create a clinical model to predict presence of a high-volume, hemodynamically significant patent ductus arteriosus (PDA) in premature infants.
Study design
A single-center retrospective cohort analysis was conducted in infants < 27 weeks gestational age who received targeted neonatal echocardiography (TNE) screening for hemodynamically significant PDA. TNEs were categorized as high-volume shunt (score ≥ 9) or no PDA/low-volume shunt (score ≤ 2) using the modified Iowa PDA score. Continuous vital sign data were evaluated in 5-minute increments for the hour preceding each TNE. A Fourier transform of the arterial blood pressure waveform was used to extract features quantifying the waveform shape. Predictor variables were used to create a logistic regression model to classify each 5-minute window as high-volume PDA or no PDA/low-volume shunt.
Results
The model included 173 TNEs (37 high-volume shunt, 136 no PDA/low-volume shunt) from 90 patients. Mean airway pressure was higher in the high-volume shunt group (P < .01), but other variables were similar. Once the best model was identified, further training 1000 times resulted in a mean testing area under the curve of 0.8891 (95% CI 0.8858, 0.8924).
Conclusions
Identification of a high-volume PDA shunt is possible with high accuracy using logistic regression modeling. Further work should focus on identification of moderate-volume shunts and correlation with clinical outcomes.
{"title":"Developing a Multivariable Prediction Model to Identify a High-Volume Patent Ductus Arteriosus in Neonates Born Extremely Preterm","authors":"Amy A. Hobson DO , Daniel Dagle BS , Craig G. Rusin PhD , Christopher J. Rhee MD, MS , Sebastian I. Acosta PhD , Patrick J. McNamara MB, BCH , Danielle R. Rios MD, MS","doi":"10.1016/j.jpeds.2025.114965","DOIUrl":"10.1016/j.jpeds.2025.114965","url":null,"abstract":"<div><h3>Objective</h3><div>To create a clinical model to predict presence of a high-volume, hemodynamically significant patent ductus arteriosus (PDA) in premature infants.</div></div><div><h3>Study design</h3><div>A single-center retrospective cohort analysis was conducted in infants < 27 weeks gestational age who received targeted neonatal echocardiography (TNE) screening for hemodynamically significant PDA. TNEs were categorized as high-volume shunt (score ≥ 9) or no PDA/low-volume shunt (score ≤ 2) using the modified Iowa PDA score. Continuous vital sign data were evaluated in 5-minute increments for the hour preceding each TNE. A Fourier transform of the arterial blood pressure waveform was used to extract features quantifying the waveform shape. Predictor variables were used to create a logistic regression model to classify each 5-minute window as high-volume PDA or no PDA/low-volume shunt.</div></div><div><h3>Results</h3><div>The model included 173 TNEs (37 high-volume shunt, 136 no PDA/low-volume shunt) from 90 patients. Mean airway pressure was higher in the high-volume shunt group (<em>P</em> < .01), but other variables were similar. Once the best model was identified, further training 1000 times resulted in a mean testing area under the curve of 0.8891 (95% CI 0.8858, 0.8924).</div></div><div><h3>Conclusions</h3><div>Identification of a high-volume PDA shunt is possible with high accuracy using logistic regression modeling. Further work should focus on identification of moderate-volume shunts and correlation with clinical outcomes.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"291 ","pages":"Article 114965"},"PeriodicalIF":3.5,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829080","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 : 2025-12-22DOI: 10.1016/j.jpeds.2025.114944
Shikha S. Sundaram MD, MSCI , Megan Kelsey MD, MS , Kristen J. Nadeau MD, MS , Emily Cooper MS , Ronald J. Sokol MD , Yamin Ma MD, PhD , Miriam Ben Abdallah MD , Alex Chaidez BA , Thomas H. Inge MD, PhD
Objective
To improve gaps in our understanding of the impact of metabolic bariatric surgery (MBS) on pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) biochemical and histologic outcomes.
Methods
We conducted a longitudinal study to determine biochemical and histologic outcomes of MASLD in adolescents undergoing MBS.
Results
In total, 101 adolescents (mean age 17.5 ± 2.1 years, 68% female, 46% Hispanic, body mass index 47.1 ± 8.4 kg/m2) underwent MBS. At MBS, 76% had an elevated alanine transaminase (ALT), 61% histologically confirmed MASLD, and 45% fibrosis. Patients with more severe histologic MASLD and fibrosis had greater ALT levels at MBS (P < .05). One-year post-MBS, patients had a mean body mass index decrease of 12.9 ± 7.9 kg/m2. ALT levels decreased from 41 ± 38 to 27 ± 33 IU/L, with 35% still having an elevated ALT. One-year post-MBS, 23 patients had repeat liver biopsy; 50% of patients experienced histologic resolution of MASH and half resolved all fibrosis, with the remainder having mild fibrosis post-MBS (P < .001).
Conclusions
The significant improvements in both biochemical and histologic MASLD observed in this study lend further credence to the utility of MBS in pediatric patients with severe obesity and MASLD.
{"title":"Resolution of Biochemical and Histologic Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Adolescents with Severe Obesity after Metabolic Bariatric Surgery","authors":"Shikha S. Sundaram MD, MSCI , Megan Kelsey MD, MS , Kristen J. Nadeau MD, MS , Emily Cooper MS , Ronald J. Sokol MD , Yamin Ma MD, PhD , Miriam Ben Abdallah MD , Alex Chaidez BA , Thomas H. Inge MD, PhD","doi":"10.1016/j.jpeds.2025.114944","DOIUrl":"10.1016/j.jpeds.2025.114944","url":null,"abstract":"<div><h3>Objective</h3><div>To improve gaps in our understanding of the impact of metabolic bariatric surgery (MBS) on pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) biochemical and histologic outcomes.</div></div><div><h3>Methods</h3><div>We conducted a longitudinal study to determine biochemical and histologic outcomes of MASLD in adolescents undergoing MBS.</div></div><div><h3>Results</h3><div>In total, 101 adolescents (mean age 17.5 ± 2.1 years, 68% female, 46% Hispanic, body mass index 47.1 ± 8.4 kg/m<sup>2</sup>) underwent MBS. At MBS, 76% had an elevated alanine transaminase (ALT), 61% histologically confirmed MASLD, and 45% fibrosis. Patients with more severe histologic MASLD and fibrosis had greater ALT levels at MBS (<em>P</em> < .05). One-year post-MBS, patients had a mean body mass index decrease of 12.9 ± 7.9 kg/m<sup>2</sup>. ALT levels decreased from 41 ± 38 to 27 ± 33 IU/L, with 35% still having an elevated ALT. One-year post-MBS, 23 patients had repeat liver biopsy; 50% of patients experienced histologic resolution of MASH and half resolved all fibrosis, with the remainder having mild fibrosis post-MBS (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>The significant improvements in both biochemical and histologic MASLD observed in this study lend further credence to the utility of MBS in pediatric patients with severe obesity and MASLD.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"291 ","pages":"Article 114944"},"PeriodicalIF":3.5,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829122","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}
To evaluate the implementation of the 2023 French Society of Neonatology (SFN) guidelines for premedication before laryngoscopy in neonates without life-threatening emergencies.
Study design
A prospective, observational cohort study was conducted across 141 French and Belgian neonatal units. Laryngoscopy data from intubation or less invasive surfactant administration in neonates <45 weeks postmenstrual age were collected. The primary outcome was the proportion of premedication consistent with SFN guidelines. Factors associated with guideline compliance were analyzed using multivariable mixed-effects logistic regression adjusted for neonatal and procedural characteristics.
Results
Six hundred seventy-three laryngoscopies were included. The mean (SD) gestational age was 30.1 (4.8) weeks. Of 506 intubations, 110 (21.7%) were immediate life-threatening emergencies. Among 396 non–life-threatening intubations, 357 (90.1%) were preceded by premedication with 169 (42.7%) consistent with SFN guidelines (propofol alone [n = 149, 37.6%]; a fast-acting opioid + muscle blocker [n = 20, 5.1%]). Independent factors associated with SFN guidelines compliance were non-emergent intubation (adjusted odds ratio 3.1 [95% CI 1.4-7.0]) and absence of hemodynamic compromise (adjusted odds ratio 31.0 [95% CI 6.4–150.3). Propofol and ketamine were the most frequent premedications before intubation, followed by opioids and/or anesthetics. Of the 167 less invasive surfactant administration procedures, 151 (90.4%) were preceded by a specific premedication including propofol (n = 84, 50.3%), consistent with SFN guidelines.
Conclusions
Ninety percent of non–life-threatening laryngoscopies were preceded by a premedication but fewer than half complied with SFN guidelines. Further studies on efficacy and tolerance of neonatal anesthetics and drugs associations are needed.
目的：评价2023年法国新生儿学会（SFN）指南在无危及生命紧急情况的新生儿喉镜检查前用药的实施情况。研究设计：一项前瞻性、观察性队列研究在141个法国和比利时新生儿单位进行。新生儿插管或低创表面活性剂给药（LISA）的喉镜检查数据结果：纳入673例喉镜检查。平均（SD）胎龄为30.1（4.8）周。在506例插管中，110例（21.7%）是危及生命的紧急情况。在396例非危及生命的插管中，357例（90.1%）术前用药，169例（42.7%）符合SFN指南（单独使用异丙酚[n=149, 37.6%]；速效阿片类药物+肌肉阻滞剂[n=20, 5.1%]）。与SFN指南依从性相关的独立因素是非紧急插管（aOR 3.1 [95% CI 1.4-7.0]）和没有血流动力学损害（aOR 31.0 [95% CI 6.4-150.3）。异丙酚和氯胺酮是插管前最常见的预用药，其次是阿片类药物和/或麻醉剂。167例LISA手术中，151例（90.4%）术前有异丙酚等特殊预用药（n=84, 50.3%），符合SFN指南。结论：90%的非危及生命的喉镜检查前进行了药物治疗，但只有不到一半的患者遵守了SFN指南。需要进一步研究新生儿麻醉药的疗效和耐受性以及药物相关性。
{"title":"A Prospective, Multicenter, Observational StUdy of PREMEdication Before Laryngoscopy in NEOnates (SUPREMEneo)","authors":"Manon Tauzin MD , Sophie Tribolet MD , Seydou Goro MSc , Xavier Durrmeyer MD, PhD , Marie Chevallier MD, PhD , Jean-Michel Roué MD, PhD , Christophe Milesi MD , Jean-Louis Chabernaud MD , Juliette Barois MD , Anne-Cécile Chary Tardy MD , Antoine Bedu MD , Noura Zayat MD , Anne Beissel MD , Claire Bellanger MD , Aurélie Desenfants MD , Riadh Boukhris MD , Anne Loose MD , Camille Jung MD, PhD , Xavier Wang PhD, MSc , Daniel Berenguer MD , Elizabeth Walter-Nicolet MD, PhD","doi":"10.1016/j.jpeds.2025.114967","DOIUrl":"10.1016/j.jpeds.2025.114967","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the implementation of the 2023 French Society of Neonatology (SFN) guidelines for premedication before laryngoscopy in neonates without life-threatening emergencies.</div></div><div><h3>Study design</h3><div>A prospective, observational cohort study was conducted across 141 French and Belgian neonatal units. Laryngoscopy data from intubation or less invasive surfactant administration in neonates <45 weeks postmenstrual age were collected. The primary outcome was the proportion of premedication consistent with SFN guidelines. Factors associated with guideline compliance were analyzed using multivariable mixed-effects logistic regression adjusted for neonatal and procedural characteristics.</div></div><div><h3>Results</h3><div>Six hundred seventy-three laryngoscopies were included. The mean (SD) gestational age was 30.1 (4.8) weeks. Of 506 intubations, 110 (21.7%) were immediate life-threatening emergencies. Among 396 non–life-threatening intubations, 357 (90.1%) were preceded by premedication with 169 (42.7%) consistent with SFN guidelines (propofol alone [n = 149, 37.6%]; a fast-acting opioid + muscle blocker [n = 20, 5.1%]). Independent factors associated with SFN guidelines compliance were non-emergent intubation (adjusted odds ratio 3.1 [95% CI 1.4-7.0]) and absence of hemodynamic compromise (adjusted odds ratio 31.0 [95% CI 6.4–150.3). Propofol and ketamine were the most frequent premedications before intubation, followed by opioids and/or anesthetics. Of the 167 less invasive surfactant administration procedures, 151 (90.4%) were preceded by a specific premedication including propofol (n = 84, 50.3%), consistent with SFN guidelines.</div></div><div><h3>Conclusions</h3><div>Ninety percent of non–life-threatening laryngoscopies were preceded by a premedication but fewer than half complied with SFN guidelines. Further studies on efficacy and tolerance of neonatal anesthetics and drugs associations are needed.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114967"},"PeriodicalIF":3.5,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812275","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 : 2025-12-20DOI: 10.1016/j.jpeds.2025.114964
Rainer Kubiak MD, PhD , Thomas Schaible MD, PhD , Christel Weiss PhD , Michael Boettcher MD, PhD , Katrin B. Zahn MD
Objective
To identify the incidence and risk factors for neurodevelopmental delay in a longitudinal cohort of children with congenital diaphragmatic hernia (CDH) with and without support with extracorporeal membrane oxygenation (ECMO).
Study design
We prospectively followed until March 2022 those children who underwent open CDH repair between 2009 and 2018 at a single institution. Standardized assessments of cognitive, language, and motor development were conducted from 6 months to 6 years of age. Delays were defined using SD thresholds. Univariable and multivariable logistic regression analyses identified risk factors for neurodevelopmental delay.
Results
Of 278 patients (130 ECMO, 148 non-ECMO), 784 assessments were completed. Cognitive delays were more common in the ECMO group; language and motor outcomes were similar. Most delays were mild. Most children had no delays in any domain by 6 years of age. In multiple regression analyses, risk factors for delays varied at different timepoints. Reoperation during the first year was negatively associated with 2-4-year cognitive function (OR 3.5, 95% CI: 1.3-9.8), expressive language (OR 2.7, 95% CI: 1.0-7.2), and motor delays (OR 2.4; 95% CI: 1.1-5.1). At 4 years, motor delays were associated with antenatal fetoscopic endoluminal tracheal occlusion (OR 4.9, 95% CI: 1.2-20.1) and abdominal wall patch (OR 4.8, 95% CI: 1.7-13.9).
Conclusions
Most children with CDH achieved normal neurodevelopment by school age. ECMO use was associated with early cognitive delays. Disease severity and surgical factors were associated with increased risk of delays, suggesting that meticulous surgical technique may protect neurodevelopmental outcomes. Timely support and standardized neurological follow-up may help to prevent or reduce long-term problems.
{"title":"Neurodevelopmental Outcome Following Open Repair of Congenital Diaphragmatic Hernia with and without Support of Extracorporeal Membrane Oxygenation: A Prospective Longitudinal Study","authors":"Rainer Kubiak MD, PhD , Thomas Schaible MD, PhD , Christel Weiss PhD , Michael Boettcher MD, PhD , Katrin B. Zahn MD","doi":"10.1016/j.jpeds.2025.114964","DOIUrl":"10.1016/j.jpeds.2025.114964","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the incidence and risk factors for neurodevelopmental delay in a longitudinal cohort of children with congenital diaphragmatic hernia (CDH) with and without support with extracorporeal membrane oxygenation (ECMO).</div></div><div><h3>Study design</h3><div>We prospectively followed until March 2022 those children who underwent open CDH repair between 2009 and 2018 at a single institution. Standardized assessments of cognitive, language, and motor development were conducted from 6 months to 6 years of age. Delays were defined using SD thresholds. Univariable and multivariable logistic regression analyses identified risk factors for neurodevelopmental delay.</div></div><div><h3>Results</h3><div>Of 278 patients (130 ECMO, 148 non-ECMO), 784 assessments were completed. Cognitive delays were more common in the ECMO group; language and motor outcomes were similar. Most delays were mild. Most children had no delays in any domain by 6 years of age. In multiple regression analyses, risk factors for delays varied at different timepoints. Reoperation during the first year was negatively associated with 2-4-year cognitive function (OR 3.5, 95% CI: 1.3-9.8), expressive language (OR 2.7, 95% CI: 1.0-7.2), and motor delays (OR 2.4; 95% CI: 1.1-5.1). At 4 years, motor delays were associated with antenatal fetoscopic endoluminal tracheal occlusion (OR 4.9, 95% CI: 1.2-20.1) and abdominal wall patch (OR 4.8, 95% CI: 1.7-13.9).</div></div><div><h3>Conclusions</h3><div>Most children with CDH achieved normal neurodevelopment by school age. ECMO use was associated with early cognitive delays. Disease severity and surgical factors were associated with increased risk of delays, suggesting that meticulous surgical technique may protect neurodevelopmental outcomes. Timely support and standardized neurological follow-up may help to prevent or reduce long-term problems.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"291 ","pages":"Article 114964"},"PeriodicalIF":3.5,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812343","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 : 2025-12-20DOI: 10.1016/j.jpeds.2025.114966
Natasha K. Nguyen MD , Terrill Bravender MD, MPH , Paula N. Goldman MD
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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.
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