Pub Date : 2024-11-28DOI: 10.1016/j.jpeds.2024.114423
Stacey Peart MBBS , Mia Kahvo MSc , Tugba Alarcon-Martinez PhD , Kate Hodgson PhD , Helen S. Eger PhD , Susan Donath MA , Louise S. Owen PhD , Peter Graham Davis PhD , Charles C. Roehr PhD , Brett J. Manley PhD
Objective
To determine whether management guidelines for infants born extremely preterm are representative for those infants <25 weeks of gestation.
Study design
Three guidelines were reviewed: the 2022 European Consensus Guidelines on the Management of Respiratory Distress Syndrome, the 2017 American Academy of Pediatrics Guidelines for Perinatal Care, and the 2020/2021 International Liaison Committee on Resuscitation guidelines. All referenced studies for overlapping recommendations were reviewed. Data extracted included the total number and proportion of infants <25 weeks of gestation in the original articles referred in the guidelines. Where the exact number of infants <25 weeks of gestation was unobtainable, this was conservatively estimated by statistical deduction.
Results
Eight recommendations were included in 2 or more guidelines: (1) antenatal corticosteroids, (2) antenatal magnesium sulfate, (3) delayed cord clamping, (4) thermoregulation at birth, (5) initial oxygen concentration at birth, (6) continuous positive airway pressure, (7) surfactant, and (8) parenteral nutrition. In total, 519 studies (n = 409 986) informed these 8 recommendations, of which 335 (64.5%) were randomized controlled trials (n = 78 325). Across all studies, an estimated 59 360 (14.5%) infants were <25 weeks of gestation. Within randomized controlled trials alone, an estimated 5873 (7.5%) infants were <25 weeks of gestation. A total of 196 (37.8%) studies did not include any infants <25 weeks of gestation.
Conclusions
Infants born <25 weeks of gestation are not well-represented in the evidence used to develop major clinical guidelines for infants born extremely preterm. Future studies should provide evidence for this population as a distinct cohort.
{"title":"Clinical Guidelines for Management of Infants Born before 25 Weeks of Gestation: How Representative Is the Current Evidence?","authors":"Stacey Peart MBBS , Mia Kahvo MSc , Tugba Alarcon-Martinez PhD , Kate Hodgson PhD , Helen S. Eger PhD , Susan Donath MA , Louise S. Owen PhD , Peter Graham Davis PhD , Charles C. Roehr PhD , Brett J. Manley PhD","doi":"10.1016/j.jpeds.2024.114423","DOIUrl":"10.1016/j.jpeds.2024.114423","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether management guidelines for infants born extremely preterm are representative for those infants <25 weeks of gestation.</div></div><div><h3>Study design</h3><div>Three guidelines were reviewed: the 2022 European Consensus Guidelines on the Management of Respiratory Distress Syndrome, the 2017 American Academy of Pediatrics Guidelines for Perinatal Care, and the 2020/2021 International Liaison Committee on Resuscitation guidelines. All referenced studies for overlapping recommendations were reviewed. Data extracted included the total number and proportion of infants <25 weeks of gestation in the original articles referred in the guidelines. Where the exact number of infants <25 weeks of gestation was unobtainable, this was conservatively estimated by statistical deduction.</div></div><div><h3>Results</h3><div>Eight recommendations were included in 2 or more guidelines: (1) antenatal corticosteroids, (2) antenatal magnesium sulfate, (3) delayed cord clamping, (4) thermoregulation at birth, (5) initial oxygen concentration at birth, (6) continuous positive airway pressure, (7) surfactant, and (8) parenteral nutrition. In total, 519 studies (n = 409 986) informed these 8 recommendations, of which 335 (64.5%) were randomized controlled trials (n = 78 325). Across all studies, an estimated 59 360 (14.5%) infants were <25 weeks of gestation. Within randomized controlled trials alone, an estimated 5873 (7.5%) infants were <25 weeks of gestation. A total of 196 (37.8%) studies did not include any infants <25 weeks of gestation.</div></div><div><h3>Conclusions</h3><div>Infants born <25 weeks of gestation are not well-represented in the evidence used to develop major clinical guidelines for infants born extremely preterm. Future studies should provide evidence for this population as a distinct cohort.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114423"},"PeriodicalIF":3.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-28DOI: 10.1016/j.jpeds.2024.114424
Tor Moberg MD , Karin Rydenman MD , Stefan Berg MD, PhD , Anders Fasth MD, PhD , Per Wekell MD, PhD
Objective
To investigate the initial and long-term clinical course of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome after tonsillectomy regarding fever episodes and nonfebrile PFAPA-related symptoms.
Study design
An observational cohort study with retrospective and cross-sectional data based on 86 of 101 patients who underwent tonsillectomy for PFAPA between January 2006 and March 2020 from a cohort of 336 patients diagnosed with PFAPA as children. Data were collected by structured telephone interviews and review of medical records. Parents were interviewed regarding initial response to tonsillectomy and the clinical course following tonsillectomy. Patients, if ≥18 years old, or parents, if patients were younger, were interviewed regarding symptoms present at the time of this long-term follow-up study.
Results
Six months after tonsillectomy, 45 of 86 participants (54%) had no symptoms of PFAPA, 19 (22%) had only nonfebrile PFAPA-related symptoms, 17 (20%) had ongoing but fewer or milder fever episodes, 1 (1%) had ongoing febrile episodes without improvement, and 4 (5%) had missing data because parents were unavailable. In 10 of 45 patients with initial remission, fever episodes reappeared 0.5-4.5 years after tonsillectomy. At long-term follow-up (median 8.8 years [range 2.8-16.1 years] after tonsillectomy), 54 of 86 (63%) had no symptoms of PFAPA, 15 (17%) had febrile episodes, generally with longer intervals between flares than before tonsillectomy, and 17 (20%) had nonfebrile PFAPA-related symptoms.
Conclusions
While PFAPA symptoms resolve or are milder post-tonsillectomy among most of the patients, the long-term outcomes showing residual symptoms among a substantial minority should be considered when evaluating tonsillectomy as a treatment option for PFAPA. Increased awareness of persistent symptoms after tonsillectomy may improve understanding and health care for these patients.
{"title":"Long-Term Symptoms in Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome after Tonsillectomy","authors":"Tor Moberg MD , Karin Rydenman MD , Stefan Berg MD, PhD , Anders Fasth MD, PhD , Per Wekell MD, PhD","doi":"10.1016/j.jpeds.2024.114424","DOIUrl":"10.1016/j.jpeds.2024.114424","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the initial and long-term clinical course of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome after tonsillectomy regarding fever episodes and nonfebrile PFAPA-related symptoms.</div></div><div><h3>Study design</h3><div>An observational cohort study with retrospective and cross-sectional data based on 86 of 101 patients who underwent tonsillectomy for PFAPA between January 2006 and March 2020 from a cohort of 336 patients diagnosed with PFAPA as children. Data were collected by structured telephone interviews and review of medical records. Parents were interviewed regarding initial response to tonsillectomy and the clinical course following tonsillectomy. Patients, if ≥18 years old, or parents, if patients were younger, were interviewed regarding symptoms present at the time of this long-term follow-up study.</div></div><div><h3>Results</h3><div>Six months after tonsillectomy, 45 of 86 participants (54%) had no symptoms of PFAPA, 19 (22%) had only nonfebrile PFAPA-related symptoms, 17 (20%) had ongoing but fewer or milder fever episodes, 1 (1%) had ongoing febrile episodes without improvement, and 4 (5%) had missing data because parents were unavailable. In 10 of 45 patients with initial remission, fever episodes reappeared 0.5-4.5 years after tonsillectomy. At long-term follow-up (median 8.8 years [range 2.8-16.1 years] after tonsillectomy), 54 of 86 (63%) had no symptoms of PFAPA, 15 (17%) had febrile episodes, generally with longer intervals between flares than before tonsillectomy, and 17 (20%) had nonfebrile PFAPA-related symptoms.</div></div><div><h3>Conclusions</h3><div>While PFAPA symptoms resolve or are milder post-tonsillectomy among most of the patients, the long-term outcomes showing residual symptoms among a substantial minority should be considered when evaluating tonsillectomy as a treatment option for PFAPA. Increased awareness of persistent symptoms after tonsillectomy may improve understanding and health care for these patients.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114424"},"PeriodicalIF":3.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755812","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}
Pub Date : 2024-11-26DOI: 10.1016/j.jpeds.2024.114422
Mary P. Mullen MD, PhD , D. Dunbar Ivy MD , Nidhy P. Varghese MD , Abbey J. Winant MD , Nahir Cortes-Santiago MD, PhD , Sara O. Vargas MD , Diego Porres MD , Nicola Maschietto MD, PhD , Paul J. Critser MD, PhD , Russel Hirsch MD , Catherine M. Avitabile MD , Rachel K. Hopper MD , Benjamin S. Frank MD , Ryan D. Coleman MD , Pankaj B. Agrawal MBBS, MMSC , Jill A. Madden PhD, MSC , Amy E. Roberts MD , Shane L. Collins BA , J. Usha Raj MD, MHA , Eric D. Austin MD, MSCI , Steven H. Abman MD
Objective
To characterize clinical, hemodynamic, imaging, and pathologic findings in children with pulmonary arterial hypertension (PAH) and variants in SRY-box transcription factor 17 (SOX17), a novel risk gene linked to heritable and congenital heart disease-associated PAH.
Study design
We assembled a multi-institutional cohort of children with PAH and SOX17 variants enrolled in the Pediatric Pulmonary Hypertension Network (PPHNet) and other registries. Subjects were identified through exome and PAH gene panel sequencing. Data were collected from registries and retrospective chart review.
Results
We identified 13 children (8 female, 5 male) aged 1.6-16 years at diagnosis with SOX17 variants and PAH. Seven patients had atrial septal defects and 2 had patent ductus arteriosus. At diagnostic cardiac catheterization, patients had severely elevated mean pulmonary artery (PA) pressure (mean 78, range 47-124 mmHg) and markedly elevated indexed pulmonary vascular resistance (mean 25.9, range 4.9-55 WU∗m2). No patients responded to acute vasodilator testing. Catheter and computed tomography angiography imaging demonstrated atypical PA anatomy including severely dilated main pulmonary arteries, lack of tapering in third and fourth order pulmonary arteries, tortuous ‘corkscrewing’ pulmonary arteries, and abnormal capillary ‘blush.’ Several children had PA stenoses and 2 had systemic arterial abnormalities. Histologic examination of explanted lungs from 3 patients disclosed plexiform arteriopathy and extensive aneurysmal dilation of alveolar septal capillaries.
Conclusions
SOX17-associated PAH is a distinctive genetic syndrome characterized by early onset severe PAH, extensive pulmonary vascular abnormalities, and high prevalence of congenital heart disease with intracardiac and interarterial shunts, suggesting a role for SOX17 in pulmonary vascular development.
{"title":"SOX17-Associated Pulmonary Hypertension in Children: A Distinct Developmental and Clinical Syndrome","authors":"Mary P. Mullen MD, PhD , D. Dunbar Ivy MD , Nidhy P. Varghese MD , Abbey J. Winant MD , Nahir Cortes-Santiago MD, PhD , Sara O. Vargas MD , Diego Porres MD , Nicola Maschietto MD, PhD , Paul J. Critser MD, PhD , Russel Hirsch MD , Catherine M. Avitabile MD , Rachel K. Hopper MD , Benjamin S. Frank MD , Ryan D. Coleman MD , Pankaj B. Agrawal MBBS, MMSC , Jill A. Madden PhD, MSC , Amy E. Roberts MD , Shane L. Collins BA , J. Usha Raj MD, MHA , Eric D. Austin MD, MSCI , Steven H. Abman MD","doi":"10.1016/j.jpeds.2024.114422","DOIUrl":"10.1016/j.jpeds.2024.114422","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize clinical, hemodynamic, imaging, and pathologic findings in children with pulmonary arterial hypertension (PAH) and variants in SRY-box transcription factor 17 (<em>SOX17</em><em>)</em>, a novel risk gene linked to heritable and congenital heart disease-associated PAH.</div></div><div><h3>Study design</h3><div>We assembled a multi-institutional cohort of children with PAH and <em>SOX17</em> variants enrolled in the Pediatric Pulmonary Hypertension Network (PPHNet) and other registries. Subjects were identified through exome and PAH gene panel sequencing. Data were collected from registries and retrospective chart review.</div></div><div><h3>Results</h3><div>We identified 13 children (8 female, 5 male) aged 1.6-16 years at diagnosis with <em>SOX17</em> variants and PAH. Seven patients had atrial septal defects and 2 had patent ductus arteriosus. At diagnostic cardiac catheterization, patients had severely elevated mean pulmonary artery (PA) pressure (mean 78, range 47-124 mmHg) and markedly elevated indexed pulmonary vascular resistance (mean 25.9, range 4.9-55 WU∗m<sup>2</sup>). No patients responded to acute vasodilator testing. Catheter and computed tomography angiography imaging demonstrated atypical PA anatomy including severely dilated main pulmonary arteries, lack of tapering in third and fourth order pulmonary arteries, tortuous ‘corkscrewing’ pulmonary arteries, and abnormal capillary ‘blush.’ Several children had PA stenoses and 2 had systemic arterial abnormalities. Histologic examination of explanted lungs from 3 patients disclosed plexiform arteriopathy and extensive aneurysmal dilation of alveolar septal capillaries.</div></div><div><h3>Conclusions</h3><div><em>SOX17</em>-associated PAH is a distinctive genetic syndrome characterized by early onset severe PAH, extensive pulmonary vascular abnormalities, and high prevalence of congenital heart disease with intracardiac and interarterial shunts, suggesting a role for <em>SOX17</em> in pulmonary vascular development.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114422"},"PeriodicalIF":3.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-26DOI: 10.1016/j.jpeds.2024.114419
Florens Lohrmann MD, PhD , Maren Doenhardt MD , Natalie Diffloth , André Jakob MD , Anton Hospach MD , Dominik T. Schneider MD , Andreas Trotter MD , Jürgen Brunner MD , Sarah Goretzki MD , Stefan Arens MD , Michael Rank , René Mauer PhD , Jakob Armann MD , Reinhard Berner MD , Markus Hufnagel MD
Objective
To elucidate how the clinical presentation of Pediatric Inflammatory Multisystem Syndrome temporally associated with Severe Acute Respiratory Syndrome-related Coronavirus 2 (PIMS-TS) was influenced by the successive variants of concern (VOC) and patient age.
Study design
A nationwide PIMS-TS registry was established in Germany in May 2020, shortly after the first cases were described in the US and United Kingdom. The registry captured information on patient characteristics, clinical course, laboratory findings, imaging, and outcome. All pediatric hospitals in Germany, along with one in Austria, were invited to participate. Between March 18, 2020, and April 30, 2023, 920 cases were reported.
Results
By examining a combination of data on clinical features, laboratory findings, treatment, imaging results, and outcomes, our analysis demonstrated disease severity to have continuously declined over the course of the Wildtype, Alpha, Delta, and Omicron waves. Based on clinical symptoms, laboratory and diagnostic findings, and intensive care unit admission rates, older children, irrespective of the related VOC, were shown to experience more severe, acute PIMS-TS; however, they had lower rates of coronary aneurysm.
Conclusions
During the course of COVID-19 pandemic, as each new VOC emerged, PIMS-TS lessened in severity. In parallel, older children came to experience more debilitating disease.
{"title":"Severity of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 Diminished During Successive Waves of the COVID-19 Pandemic: Data from a Nationwide German Survey","authors":"Florens Lohrmann MD, PhD , Maren Doenhardt MD , Natalie Diffloth , André Jakob MD , Anton Hospach MD , Dominik T. Schneider MD , Andreas Trotter MD , Jürgen Brunner MD , Sarah Goretzki MD , Stefan Arens MD , Michael Rank , René Mauer PhD , Jakob Armann MD , Reinhard Berner MD , Markus Hufnagel MD","doi":"10.1016/j.jpeds.2024.114419","DOIUrl":"10.1016/j.jpeds.2024.114419","url":null,"abstract":"<div><h3>Objective</h3><div>To elucidate how the clinical presentation of Pediatric Inflammatory Multisystem Syndrome temporally associated with Severe Acute Respiratory Syndrome-related Coronavirus 2 (PIMS-TS) was influenced by the successive variants of concern (VOC) and patient age.</div></div><div><h3>Study design</h3><div>A nationwide PIMS-TS registry was established in Germany in May 2020, shortly after the first cases were described in the US and United Kingdom. The registry captured information on patient characteristics, clinical course, laboratory findings, imaging, and outcome. All pediatric hospitals in Germany, along with one in Austria, were invited to participate. Between March 18, 2020, and April 30, 2023, 920 cases were reported.</div></div><div><h3>Results</h3><div>By examining a combination of data on clinical features, laboratory findings, treatment, imaging results, and outcomes, our analysis demonstrated disease severity to have continuously declined over the course of the Wildtype, Alpha, Delta, and Omicron waves. Based on clinical symptoms, laboratory and diagnostic findings, and intensive care unit admission rates, older children, irrespective of the related VOC, were shown to experience more severe, acute PIMS-TS; however, they had lower rates of coronary aneurysm.</div></div><div><h3>Conclusions</h3><div>During the course of COVID-19 pandemic, as each new VOC emerged, PIMS-TS lessened in severity. In parallel, older children came to experience more debilitating disease.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114419"},"PeriodicalIF":3.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741497","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}
Pub Date : 2024-11-22DOI: 10.1016/j.jpeds.2024.114416
Jacopo Bonet PhD , Silvia Guiducci MD , Giulia Res MD , Sabrina Brigadoi PhD , Sarbattama Sen MD , Paolo Montaldo MD , Elena Priante MD , Nicola Santoro MD, PhD , Daniele Trevisanuto MD , Eugenio Baraldi MD , Chiara Dalla Man PhD , Alfonso Galderisi MD, PhD
Objective
To evaluate the accuracy of a device for continuous glucose monitoring (CGM) among infants born preterm admitted to the neonatal intensive care unit.
Study design
We analyzed paired CGM sensor glucose (SG) and point-of-care blood glucose (BG) measurements collected in infants born at ≤32 weeks of gestation or with a birth weight ≤1500 g. CGM was initiated within 48 hours from birth and maintained for 5 days. BG was performed every 12 hours and used to calibrate the sensor. Measures of CGM accuracy were computed from SG and BG pairs.
Results
We included 501 SG-BG paired measurements from 51 infants (age 30.5 weeks [IQR 29.0-31.0 weeks], birth weight 1400 g [IQR 1100-1500 g] with at least 24 hours of CGM data. The mean absolute relative difference (MARD) between SG and point-of-care BG measures was 7.1% [IQR 5.6-9.3], corresponding to a difference of −5.6 mg/dL [95% CI −25 to +14 mg/dl]. The median sensor use was 96 hours [IQR 72-120] with 2.0 [IQR 1.7-2.4] calibrations per day.
Conclusions
Accuracy of SG measurements compared with BG measurements appears to be acceptable in a clinical study setting, with a negligible difference between SG and BG. Our data suggest that SG use may be clinically acceptable when the sensor is regularly calibrated.
{"title":"Continuous Glucose Monitoring among Infants Born Very Preterm: Evidence for Accuracy in Neonatal Intensive Care","authors":"Jacopo Bonet PhD , Silvia Guiducci MD , Giulia Res MD , Sabrina Brigadoi PhD , Sarbattama Sen MD , Paolo Montaldo MD , Elena Priante MD , Nicola Santoro MD, PhD , Daniele Trevisanuto MD , Eugenio Baraldi MD , Chiara Dalla Man PhD , Alfonso Galderisi MD, PhD","doi":"10.1016/j.jpeds.2024.114416","DOIUrl":"10.1016/j.jpeds.2024.114416","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the accuracy of a device for continuous glucose monitoring (CGM) among infants born preterm admitted to the neonatal intensive care unit.</div></div><div><h3>Study design</h3><div>We analyzed paired CGM sensor glucose (SG) and point-of-care blood glucose (BG) measurements collected in infants born at ≤32 weeks of gestation or with a birth weight ≤1500 g. CGM was initiated within 48 hours from birth and maintained for 5 days. BG was performed every 12 hours and used to calibrate the sensor. Measures of CGM accuracy were computed from SG and BG pairs.</div></div><div><h3>Results</h3><div>We included 501 SG-BG paired measurements from 51 infants (age 30.5 weeks [IQR 29.0-31.0 weeks], birth weight 1400 g [IQR 1100-1500 g] with at least 24 hours of CGM data. The mean absolute relative difference (MARD) between SG and point-of-care BG measures was 7.1% [IQR 5.6-9.3], corresponding to a difference of −5.6 mg/dL [95% CI −25 to +14 mg/dl]. The median sensor use was 96 hours [IQR 72-120] with 2.0 [IQR 1.7-2.4] calibrations per day.</div></div><div><h3>Conclusions</h3><div>Accuracy of SG measurements compared with BG measurements appears to be acceptable in a clinical study setting, with a negligible difference between SG and BG. Our data suggest that SG use may be clinically acceptable when the sensor is regularly calibrated.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114416"},"PeriodicalIF":3.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/j.jpeds.2024.114415
Marie-Coralie Cornet MD, PhD , Fernando F. Gonzalez MD , Hannah C. Glass MDCM, MAS , Tai-Wei Wu MD , Jessica L. Wisnowski PhD , Yi Li MD , Patrick Heagerty PhD , Sandra E. Juul MD, PhD , Yvonne W. Wu MD, MPH
Objective
To determine if chorioamnionitis is associated with an increased risk of adverse 2-year outcomes among infants with hypoxic-ischemic encephalopathy (HIE).
Study design
This cohort study included all infants with moderate to severe HIE treated with therapeutic hypothermia and enrolled on the High-dose Erythropoietin for Asphyxia and Encephalopathy Trial. Clinical chorioamnionitis (CC) was defined as a diagnosis made by a treating obstetrician and histologic chorioamnionitis (HC) was defined as placental inflammation observed on histology. We used proportional odds regression to determine the associations between CC, HC, and an ordinal 2-year neurodevelopmental outcome measure: no neurodevelopmental impairment (NDI), mild NDI, moderate NDI, severe NDI, or death.
Results
Of 500 infants, 65 (13%) were exposed to CC. Of 317 infants with placental data available, 125 (39%) were exposed to HC. Infants exposed to CC (odds ratio 0.57, 95% CI 0.34-0.95) and those exposed to HC (odds ratio 0.62, 95% CI 0.40-0.96) had a lower severity of primary outcome than unexposed infants. Infants exposed to chorioamnionitis also had lower frequencies of sentinel events (CC: P = .001; HC: P = .005), central pattern magnetic resonance imaging brain injury (CC: P = .02; HC: P = .02), and electroencephalogram background abnormalities (CC: P = .046; HC: P = .02), compared with unexposed infants.
Conclusions
Infants with HIE who were exposed to chorioamnionitis had lower severity of 2-year outcomes than unexposed infants. Our findings suggest that chorioamnionitis may lead to a lower severity of brain dysfunction than other pathophysiologic mechanisms of encephalopathy.
研究目的研究设计：这项队列研究纳入了所有接受治疗性低温治疗的中重度缺氧缺血性脑病婴儿，他们都参加了 "高剂量促红细胞生成素治疗窒息和脑病（HEAL）试验"。临床绒毛膜羊膜炎（CC）是指由主治产科医生做出的诊断，组织学绒毛膜羊膜炎（HC）是指在组织学上观察到的胎盘炎症。我们采用比例几率回归法确定CC、HC与2年神经发育结果（无神经发育障碍（NDI）、轻度NDI、中度NDI、重度NDI或死亡）之间的关系：在500名婴儿中，有65名（13%）接触过CC。在317名有胎盘数据的婴儿中，125名（39%）暴露于HC。与未暴露的婴儿相比，暴露于CC（OR 0.57，95% CI 0.34-0.95）和HC（OR 0.62，95% CI 0.40-0.96）的婴儿主要结果的严重程度较低。与未暴露的婴儿相比，暴露于绒毛膜羊膜炎的婴儿发生哨点事件（CC：P=0.001；HC：P=0.005）、中央模式磁共振成像脑损伤（CC：P=0.02；HC：P=0.02）和脑电图背景异常（CC：P=0.046；HC：P=0.02）的频率也较低：结论：与未暴露于绒毛膜羊膜炎的婴儿相比，暴露于绒毛膜羊膜炎的 HIE 婴儿 2 年后的严重程度较低。我们的研究结果表明，与脑病的其他病理生理机制相比，绒毛膜羊膜炎可能导致脑功能障碍的严重程度较低。
{"title":"Chorioamnionitis and Two-Year Outcomes in Infants with Hypoxic-Ischemic Encephalopathy","authors":"Marie-Coralie Cornet MD, PhD , Fernando F. Gonzalez MD , Hannah C. Glass MDCM, MAS , Tai-Wei Wu MD , Jessica L. Wisnowski PhD , Yi Li MD , Patrick Heagerty PhD , Sandra E. Juul MD, PhD , Yvonne W. Wu MD, MPH","doi":"10.1016/j.jpeds.2024.114415","DOIUrl":"10.1016/j.jpeds.2024.114415","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if chorioamnionitis is associated with an increased risk of adverse 2-year outcomes among infants with hypoxic-ischemic encephalopathy (HIE).</div></div><div><h3>Study design</h3><div>This cohort study included all infants with moderate to severe HIE treated with therapeutic hypothermia and enrolled on the High-dose Erythropoietin for Asphyxia and Encephalopathy Trial. Clinical chorioamnionitis (CC) was defined as a diagnosis made by a treating obstetrician and histologic chorioamnionitis (HC) was defined as placental inflammation observed on histology. We used proportional odds regression to determine the associations between CC, HC, and an ordinal 2-year neurodevelopmental outcome measure: no neurodevelopmental impairment (NDI), mild NDI, moderate NDI, severe NDI, or death.</div></div><div><h3>Results</h3><div>Of 500 infants, 65 (13%) were exposed to CC. Of 317 infants with placental data available, 125 (39%) were exposed to HC. Infants exposed to CC (odds ratio 0.57, 95% CI 0.34-0.95) and those exposed to HC (odds ratio 0.62, 95% CI 0.40-0.96) had a lower severity of primary outcome than unexposed infants. Infants exposed to chorioamnionitis also had lower frequencies of sentinel events (CC: <em>P</em> = .001; HC: <em>P</em> = .005), central pattern magnetic resonance imaging brain injury (CC: <em>P</em> = .02; HC: <em>P</em> = .02), and electroencephalogram background abnormalities (CC: <em>P</em> = .046; HC: <em>P</em> = .02), compared with unexposed infants.</div></div><div><h3>Conclusions</h3><div>Infants with HIE who were exposed to chorioamnionitis had lower severity of 2-year outcomes than unexposed infants. Our findings suggest that chorioamnionitis may lead to a lower severity of brain dysfunction than other pathophysiologic mechanisms of encephalopathy.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114415"},"PeriodicalIF":3.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692727","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}
Pub Date : 2024-11-21DOI: 10.1016/j.jpeds.2024.114420
Lea Lenglart, Luigi Titomanlio, Zsolt Bognar, Silvia Bressan, Danilo Buonsenso, Tisham De, Ruth Farrugia, Kate Honeyford, Ian K Maconochie, Henriette A Moll, Rianne Oostenbrink, Niccolo Parri, Damian Roland, Esra Akyüz Özkan, Laura Almeida, Ilaria Alberti, François Angoulvant, Zein Assad, Camille Aupiais, Michael Barrett, Romain Basmaci, Dorine Borensztajn, Susana Castanhinha, Antonio Chiaretti, Robert Cohen, Sheena Durnin, Patrick Fitzpatrick, Susanne Greber-Platzer, Romain Guedj, Florian Hey, Lina Jankauskaite, Kristina Keitel, Ines Mascarenhas, Gregorio P Milani, Anna Maria Musolino, Zanda Pučuka, Malin Ryd Rinder, Maria Chiara Supino, Francesca Tirelli, Ruud G Nijman, Naim Ouldali
Objective: To investigate a dose-response relationship between the magnitude of decrease in pediatric respiratory tract infections (RTI) during the 2020 implementation of non-pharmaceutical interventions (NPI) and the rise thereafter during NPI lifting.
Study design: We conducted an interrupted, time-series analysis, based on a multinational surveillance system. All patients <16 years of age coming to medical attention with various symptoms and signs of RTI at 25 pediatric emergency departments from 13 European countries between January 2018 and June 2022 were included. We used generalized additive models to correlate the magnitude of decrease of each RTI during NPI (such as social distancing) implementation and its subsequent increase during NPI lifting. Urinary tract infections (UTI) served as control outcome.
Results: 528,055 patients were included. We observed reductions in cases during the NPI period, from -76% (95%CI -113;-53) in pneumonia) to -65% (95%CI[-100;-39) for tonsillitis/pharyngitis), followed by strong increases during NPI lifting, from +83% (95%CI 29;150) for tonsillitis/pharyngitis) to +329% (95%CI (149;517) bronchiolitis). For each RTI, we found a significant association between the magnitude of decrease during NPI implementation and the increase during NPI lifting. UTI cases remained stable.
Conclusions: The magnitude of increase in RTI observed following NPI lifting was directly correlated to the magnitude of cases' reduction during NPI implementation, suggesting a "dose-response" relationship from an "immune debt" phenomenon. The likely rebound in RTIs should be expected when implementing and lifting NPI in the future.
{"title":"Surge of Pediatric Respiratory Tract Infections After the COVID-19 Pandemic and the Concept of \"Immune Debt\".","authors":"Lea Lenglart, Luigi Titomanlio, Zsolt Bognar, Silvia Bressan, Danilo Buonsenso, Tisham De, Ruth Farrugia, Kate Honeyford, Ian K Maconochie, Henriette A Moll, Rianne Oostenbrink, Niccolo Parri, Damian Roland, Esra Akyüz Özkan, Laura Almeida, Ilaria Alberti, François Angoulvant, Zein Assad, Camille Aupiais, Michael Barrett, Romain Basmaci, Dorine Borensztajn, Susana Castanhinha, Antonio Chiaretti, Robert Cohen, Sheena Durnin, Patrick Fitzpatrick, Susanne Greber-Platzer, Romain Guedj, Florian Hey, Lina Jankauskaite, Kristina Keitel, Ines Mascarenhas, Gregorio P Milani, Anna Maria Musolino, Zanda Pučuka, Malin Ryd Rinder, Maria Chiara Supino, Francesca Tirelli, Ruud G Nijman, Naim Ouldali","doi":"10.1016/j.jpeds.2024.114420","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114420","url":null,"abstract":"<p><strong>Objective: </strong>To investigate a dose-response relationship between the magnitude of decrease in pediatric respiratory tract infections (RTI) during the 2020 implementation of non-pharmaceutical interventions (NPI) and the rise thereafter during NPI lifting.</p><p><strong>Study design: </strong>We conducted an interrupted, time-series analysis, based on a multinational surveillance system. All patients <16 years of age coming to medical attention with various symptoms and signs of RTI at 25 pediatric emergency departments from 13 European countries between January 2018 and June 2022 were included. We used generalized additive models to correlate the magnitude of decrease of each RTI during NPI (such as social distancing) implementation and its subsequent increase during NPI lifting. Urinary tract infections (UTI) served as control outcome.</p><p><strong>Results: </strong>528,055 patients were included. We observed reductions in cases during the NPI period, from -76% (95%CI -113;-53) in pneumonia) to -65% (95%CI[-100;-39) for tonsillitis/pharyngitis), followed by strong increases during NPI lifting, from +83% (95%CI 29;150) for tonsillitis/pharyngitis) to +329% (95%CI (149;517) bronchiolitis). For each RTI, we found a significant association between the magnitude of decrease during NPI implementation and the increase during NPI lifting. UTI cases remained stable.</p><p><strong>Conclusions: </strong>The magnitude of increase in RTI observed following NPI lifting was directly correlated to the magnitude of cases' reduction during NPI implementation, suggesting a \"dose-response\" relationship from an \"immune debt\" phenomenon. The likely rebound in RTIs should be expected when implementing and lifting NPI in the future.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114420"},"PeriodicalIF":3.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-17DOI: 10.1016/j.jpeds.2024.114412
Renée A. Shellhaas MD, MS , Linda S. Franck RN, PhD , Betsy Pilon BA , Courtney J. Wusthoff MD, MS , Shavonne L. Massey MD, MSCE , Catherine J. Chu MD, MS , Janet S. Soul MDCM , Monica E. Lemmon MD , Adam L. Numis MD , Julie S. Sturza MPH , Cameron Thomas MD, MS , Giulia M. Benedetti MD , Stephanie M.D. Rau BS, CCRP , Tayyba Anwar MD , Madison M. Berl PhD , Charles E. McCulloch PhD , Hannah C. Glass MDCM, MAS
Objective
To evaluate whether abnormal sleep is associated with adverse outcomes for children who survived acute provoked neonatal seizures, and their parents.
Study design
This 9-center study prospectively followed newborns with acute provoked seizures. When children reached age 5 years, parents completed the Children's Sleep Habits Questionnaire (CSHQ), the Pediatric Sleep Questionnaire–Sleep Related Breathing Disorders (PSQ-SRBD) subscale, the Vineland Adaptive Behavior Scales–3, and the Hospital Anxiety Depression Scale. Children were also assessed with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Spearman correlations and multivariable analyses were used to evaluate risk factors for sleep problems.
Results
The mean CSHQ score was 45 ± 7; 77 of 118 children (65%) had an abnormal score (above the healthy sleep threshold of 41). On the PSQ-SRBD, 32 of 119 children (27%) screened positive for sleep-disordered breathing (SDB). SDB symptoms were more common among children with cerebral palsy (42% with vs 22% without; P = .03) and epilepsy (54% with vs 24% without; P = .02). Children with lower scores on the Vineland-3 (rho = −0.25; P = .01) and WPPSI-IV (rho = −0.31; P = .004) at 5 years of age were more likely to have symptoms of SDB. Worse CSHQ and PSQ-SRBD scores were associated with higher parental anxiety (rho = 0.28 [P = .002] and rho = 0.34 [P = .0002], respectively) and depression scores on the Hospital Anxiety Depression Scale (rho = 0.16 [P = .08] and rho = 0.17 [P = .07], respectively).
Conclusions
Two-thirds of early school-aged survivors of acute provoked neonatal seizures had parent-reported sleep abnormalities and one-quarter screened positive for SDB. Early screening and effective treatment for sleep disorders could be an innovative, practice-changing approach to improve outcomes after neonatal seizures.
{"title":"Sleep Disorders Five Years After Acute Provoked Neonatal Seizures","authors":"Renée A. Shellhaas MD, MS , Linda S. Franck RN, PhD , Betsy Pilon BA , Courtney J. Wusthoff MD, MS , Shavonne L. Massey MD, MSCE , Catherine J. Chu MD, MS , Janet S. Soul MDCM , Monica E. Lemmon MD , Adam L. Numis MD , Julie S. Sturza MPH , Cameron Thomas MD, MS , Giulia M. Benedetti MD , Stephanie M.D. Rau BS, CCRP , Tayyba Anwar MD , Madison M. Berl PhD , Charles E. McCulloch PhD , Hannah C. Glass MDCM, MAS","doi":"10.1016/j.jpeds.2024.114412","DOIUrl":"10.1016/j.jpeds.2024.114412","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether abnormal sleep is associated with adverse outcomes for children who survived acute provoked neonatal seizures, and their parents.</div></div><div><h3>Study design</h3><div>This 9-center study prospectively followed newborns with acute provoked seizures. When children reached age 5 years, parents completed the Children's Sleep Habits Questionnaire (CSHQ), the Pediatric Sleep Questionnaire–Sleep Related Breathing Disorders (PSQ-SRBD) subscale, the Vineland Adaptive Behavior Scales–3, and the Hospital Anxiety Depression Scale. Children were also assessed with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Spearman correlations and multivariable analyses were used to evaluate risk factors for sleep problems.</div></div><div><h3>Results</h3><div>The mean CSHQ score was 45 ± 7; 77 of 118 children (65%) had an abnormal score (above the healthy sleep threshold of 41). On the PSQ-SRBD, 32 of 119 children (27%) screened positive for sleep-disordered breathing (SDB). SDB symptoms were more common among children with cerebral palsy (42% with vs 22% without; <em>P</em> = .03) and epilepsy (54% with vs 24% without; <em>P</em> = .02). Children with lower scores on the Vineland-3 (<em>rho</em> = −0.25; <em>P</em> = .01) and WPPSI-IV (<em>rho</em> = −0.31; <em>P</em> = .004) at 5 years of age were more likely to have symptoms of SDB. Worse CSHQ and PSQ-SRBD scores were associated with higher parental anxiety (<em>rho</em> = 0.28 [<em>P</em> = .002] and <em>rho</em> = 0.34 [<em>P</em> = .0002], respectively) and depression scores on the Hospital Anxiety Depression Scale (<em>rho</em> = 0.16 [<em>P</em> = .08] and <em>rho</em> = 0.17 [<em>P</em> = .07], respectively).</div></div><div><h3>Conclusions</h3><div>Two-thirds of early school-aged survivors of acute provoked neonatal seizures had parent-reported sleep abnormalities and one-quarter screened positive for SDB. Early screening and effective treatment for sleep disorders could be an innovative, practice-changing approach to improve outcomes after neonatal seizures.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114412"},"PeriodicalIF":3.9,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.jpeds.2024.114353
Sarah S. Long MD
{"title":"New Technologies Bring New Questions in Perinatal HSV","authors":"Sarah S. Long MD","doi":"10.1016/j.jpeds.2024.114353","DOIUrl":"10.1016/j.jpeds.2024.114353","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"275 ","pages":"Article 114353"},"PeriodicalIF":3.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.jpeds.2024.114354
Raye-Ann deRegnier MD
{"title":"Substantiating the Need for NICU “Follow Through”","authors":"Raye-Ann deRegnier MD","doi":"10.1016/j.jpeds.2024.114354","DOIUrl":"10.1016/j.jpeds.2024.114354","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"275 ","pages":"Article 114354"},"PeriodicalIF":3.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655156","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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