Pub Date : 2024-11-09DOI: 10.1016/S0022-3476(24)00452-9
{"title":"Information for Readers","authors":"","doi":"10.1016/S0022-3476(24)00452-9","DOIUrl":"10.1016/S0022-3476(24)00452-9","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"275 ","pages":"Article 114349"},"PeriodicalIF":3.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655103","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 : 2024-11-08DOI: 10.1016/j.jpeds.2024.114391
Sara B. DeMauro MD, MSCE , Erik A. Jensen MD, MSCE , Scott A. McDonald BS , Susan Hintz MD, MS , Jon Tyson MD , David K. Stevenson MD , Martin L. Blakely MD, MS
The multicenter Necrotizing Enterocolitis Surgery Trial compared initial peritoneal drainage with laparotomy among infants with extremely low birth weight and surgical necrotizing enterocolitis or intestinal perforation. In this post hoc analysis of trial data, initial drainage was associated with adverse respiratory outcomes, both in hospital and through 2 years corrected age.
{"title":"Respiratory Outcomes of Infants Born Extremely Preterm in the Necrotizing Enterocolitis Surgery Trial","authors":"Sara B. DeMauro MD, MSCE , Erik A. Jensen MD, MSCE , Scott A. McDonald BS , Susan Hintz MD, MS , Jon Tyson MD , David K. Stevenson MD , Martin L. Blakely MD, MS","doi":"10.1016/j.jpeds.2024.114391","DOIUrl":"10.1016/j.jpeds.2024.114391","url":null,"abstract":"<div><div>The multicenter Necrotizing Enterocolitis Surgery Trial compared initial peritoneal drainage with laparotomy among infants with extremely low birth weight and surgical necrotizing enterocolitis or intestinal perforation. In this post hoc analysis of trial data, initial drainage was associated with adverse respiratory outcomes, both in hospital and through 2 years corrected age.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114391"},"PeriodicalIF":3.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632635","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 : 2024-11-07DOI: 10.1016/j.jpeds.2024.114390
Matthew J Kielt, Isabella Zaniletti, Joanne M Lagatta, Michael A Padula, Theresa R Grover, Nicolas F M Porta, Erica M Wymore, Erik A Jensen, Kristen T Leeman, Jonathan C Levin, Jacquelyn R Evans, Sushmita Yallapragada, Leif D Nelin, Shilpa Vyas-Read, Karna Murthy
Objective: To estimate the association between the mode of respiratory support administered at 36 weeks' post-menstrual age (PMA) with time-to-liberation from respiratory support (LRS) in infants with grade 2/3 bronchopulmonary dysplasia (BPD).
Study design: Daily respiratory support data were abstracted for infants born <32 weeks' gestation with grade 2/3 BPD enrolled in the Children's Hospitals Neonatal Database between 2017 and 2022. The main exposure was the mode of respiratory support received at 36 weeks' PMA: high flow nasal cannula >2 L/min (HFNC), continuous positive airway pressure (CPAP), non-invasive positive pressure ventilation (NIPPV), or mechanical ventilation (MV). The primary outcome was time-to-LRS, defined as the PMA when infants weaned to nasal cannula <2 L/min or room air for >2 days. The independent association between the main exposure and time-to-LRS was estimated using restricted mean survival time analysis.
Results: Among 3,483 included infants from 41 centers, 17% received HFNC, 36% CPAP, 16% NIPPV, and 32% MV at 36 weeks' PMA. After censoring those who died (4.2%), survived with tracheostomy (7.6%), or were transferred to another facility (7.5%), the median (IQR) time-to-LRS differed between groups: HFNC 37 [37, 39]; CPAP 39 [37, 41] NIPPV 41[39, 45]; and MV 44 [40, 48] weeks' PMA (P<0.001). Across centers, a 10-fold difference in time-to-LRS was observed after adjustment for clinical risk factors.
Conclusions: For infants with grade 2/3 BPD, the mode of respiratory support prescribed at 36 weeks' PMA and center of care were each associated with time-to-LRS independent of patient and clinical characteristics.
{"title":"Liberation from Respiratory Support in Bronchopulmonary Dysplasia.","authors":"Matthew J Kielt, Isabella Zaniletti, Joanne M Lagatta, Michael A Padula, Theresa R Grover, Nicolas F M Porta, Erica M Wymore, Erik A Jensen, Kristen T Leeman, Jonathan C Levin, Jacquelyn R Evans, Sushmita Yallapragada, Leif D Nelin, Shilpa Vyas-Read, Karna Murthy","doi":"10.1016/j.jpeds.2024.114390","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114390","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the association between the mode of respiratory support administered at 36 weeks' post-menstrual age (PMA) with time-to-liberation from respiratory support (LRS) in infants with grade 2/3 bronchopulmonary dysplasia (BPD).</p><p><strong>Study design: </strong>Daily respiratory support data were abstracted for infants born <32 weeks' gestation with grade 2/3 BPD enrolled in the Children's Hospitals Neonatal Database between 2017 and 2022. The main exposure was the mode of respiratory support received at 36 weeks' PMA: high flow nasal cannula >2 L/min (HFNC), continuous positive airway pressure (CPAP), non-invasive positive pressure ventilation (NIPPV), or mechanical ventilation (MV). The primary outcome was time-to-LRS, defined as the PMA when infants weaned to nasal cannula <2 L/min or room air for >2 days. The independent association between the main exposure and time-to-LRS was estimated using restricted mean survival time analysis.</p><p><strong>Results: </strong>Among 3,483 included infants from 41 centers, 17% received HFNC, 36% CPAP, 16% NIPPV, and 32% MV at 36 weeks' PMA. After censoring those who died (4.2%), survived with tracheostomy (7.6%), or were transferred to another facility (7.5%), the median (IQR) time-to-LRS differed between groups: HFNC 37 [37, 39]; CPAP 39 [37, 41] NIPPV 41[39, 45]; and MV 44 [40, 48] weeks' PMA (P<0.001). Across centers, a 10-fold difference in time-to-LRS was observed after adjustment for clinical risk factors.</p><p><strong>Conclusions: </strong>For infants with grade 2/3 BPD, the mode of respiratory support prescribed at 36 weeks' PMA and center of care were each associated with time-to-LRS independent of patient and clinical characteristics.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114390"},"PeriodicalIF":3.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632497","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 : 2024-11-06DOI: 10.1016/j.jpeds.2024.114388
Nikita S. Kalluri MD, MPH , Erika G. Cordova-Ramos MD , Sunah S. Hwang MD, MPH, PhD , Katherine R. Standish MD, MS , Margaret G. Parker MD, MPH
National breastfeeding (direct breastfeeding and/or provision of pumped breast milk) rates among preterm infants are unclear. We report rates of breastfeeding initiation and continuation at 12 weeks after birth by gestational age category from a nationally representative survey between 2009 and 2019. Breastfeeding rates were lowest among infants born late preterm compared with other gestational age categories.
{"title":"National Trends in Breastfeeding by Gestational Age Category","authors":"Nikita S. Kalluri MD, MPH , Erika G. Cordova-Ramos MD , Sunah S. Hwang MD, MPH, PhD , Katherine R. Standish MD, MS , Margaret G. Parker MD, MPH","doi":"10.1016/j.jpeds.2024.114388","DOIUrl":"10.1016/j.jpeds.2024.114388","url":null,"abstract":"<div><div>National breastfeeding (direct breastfeeding and/or provision of pumped breast milk) rates among preterm infants are unclear. We report rates of breastfeeding initiation and continuation at 12 weeks after birth by gestational age category from a nationally representative survey between 2009 and 2019. Breastfeeding rates were lowest among infants born late preterm compared with other gestational age categories.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114388"},"PeriodicalIF":3.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632514","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 examine cardiopulmonary physiological alterations associated with hypoxemic respiratory failure (HRF; fraction of inspired oxygen ≥0.60) among preterm neonates requiring vasopressors/inotropes during sepsis (septic shock).
Study design
We conducted a retrospective cohort study from 2015 through 2022 at a tertiary neonatal intensive care unit. Neonates <34 weeks gestational age who had septic shock and underwent a comprehensive targeted neonatal echocardiography (TNE) ≤72 hours of sepsis onset were included. TNE findings of patients with shock and HRF were compared with those with shock without HRF. Indices of pulmonary vascular resistance (PVR), right ventricular (RV) and left ventricular (LV) systolic and diastolic function, measured using conventional, tissue Doppler imaging and speckle-tracking echocardiography, were examined.
Results
Of 52 included infants with septic shock, 19 (37%) also had HRF. Baseline characteristics were similar. On TNE, although the HRF group more frequently had bidirectional/right-to-left flow across the patent ductus arteriosus (67% vs 33%; P = .08), all indices of PVR and RV function were similar. However, the HRF group demonstrated reduced LV systolic function (ejection fraction, 51.8% ± 12.3% vs 62.6% ± 13.0%; global peak systolic longitudinal strain −15.2% ± 4.5% vs −18.6% ± 4.5%), diastolic function (early [2.3 ± 1.0/s vs 3.6 ± 1.2/s]) and late (2.4/s [IQR, 1.9-2.6/s] vs 2.8/s [2.3-3.5/s] diastolic strain rate), and higher frequency of LV output <150 mL/min/kg (44% vs 12%) (all P < .05).
Conclusions
Acute HRF occurring in preterm neonates with septic shock is associated with alterations in TNE measures of LV function, and not PVR or RV function. Future studies should evaluate the impact of supporting LV function in these patients.
目的研究设计：我们在一家三级新生儿重症监护病房开展了一项回顾性队列研究，研究时间为 2015 年至 2022 年。新生儿 结果：在纳入的 52 名脓毒性休克婴儿中，19 名（37%）同时患有 HRF。基线特征相似。在TNE检查中，虽然HRF组更常见双向/右向左血流通过动脉导管未闭（67%对33%；P=0.08），但PVR和RV功能的所有指标均相似。然而，HRF 组显示出左心室收缩功能减弱[射血分数：51.8±12.3 vs. 51.8±12.3 vs. 51.8±12.3] ：51.8±12.3 vs. 62.6±13.0%；整体收缩期纵向应变峰值-15.2±4.5 vs. -18.6±4.5%]，舒张功能[早期（2.3±1.0 vs. 3.6±1.2 /s）和晚期（2.4 (1.9, 2.6) vs. 2.8 (2.3, 3.5) /s）舒张应变率]降低，左心室输出频率升高 结论：早产新生儿脓毒性休克时发生的急性 HRF 与 TNE 测量的左心室功能变化有关，而与 PVR 或 RV 功能无关。未来的研究应评估支持左心室功能对这些患者的影响。
{"title":"Cardiopulmonary Physiology of Hypoxemic Respiratory Failure Among Preterm Infants with Septic Shock","authors":"Ashraf Kharrat MD, MSc(HQ) , Sagee Nissimov MD, BSc , Faith Zhu MBChB, MRCPCH , Poorva Deshpande MBBS, MRCPCH, MSc , Amish Jain MBBS, MRCPCH, PhD","doi":"10.1016/j.jpeds.2024.114384","DOIUrl":"10.1016/j.jpeds.2024.114384","url":null,"abstract":"<div><h3>Objective</h3><div>To examine cardiopulmonary physiological alterations associated with hypoxemic respiratory failure (HRF; fraction of inspired oxygen ≥0.60) among preterm neonates requiring vasopressors/inotropes during sepsis (septic shock).</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study from 2015 through 2022 at a tertiary neonatal intensive care unit. Neonates <34 weeks gestational age who had septic shock and underwent a comprehensive targeted neonatal echocardiography (TNE) ≤72 hours of sepsis onset were included. TNE findings of patients with shock and HRF were compared with those with shock without HRF. Indices of pulmonary vascular resistance (PVR), right ventricular (RV) and left ventricular (LV) systolic and diastolic function, measured using conventional, tissue Doppler imaging and speckle-tracking echocardiography, were examined.</div></div><div><h3>Results</h3><div>Of 52 included infants with septic shock, 19 (37%) also had HRF. Baseline characteristics were similar. On TNE, although the HRF group more frequently had bidirectional/right-to-left flow across the patent ductus arteriosus (67% vs 33%; <em>P</em> = .08), all indices of PVR and RV function were similar. However, the HRF group demonstrated reduced LV systolic function (ejection fraction, 51.8% ± 12.3% vs 62.6% ± 13.0%; global peak systolic longitudinal strain −15.2% ± 4.5% vs −18.6% ± 4.5%), diastolic function (early [2.3 ± 1.0/s vs 3.6 ± 1.2/s]) and late (2.4/s [IQR, 1.9-2.6/s] vs 2.8/s [2.3-3.5/s] diastolic strain rate), and higher frequency of LV output <150 mL/min/kg (44% vs 12%) (all <em>P</em> < .05).</div></div><div><h3>Conclusions</h3><div>Acute HRF occurring in preterm neonates with septic shock is associated with alterations in TNE measures of LV function, and not PVR or RV function. Future studies should evaluate the impact of supporting LV function in these patients.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114384"},"PeriodicalIF":3.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606565","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 : 2024-11-05DOI: 10.1016/j.jpeds.2024.114389
Alexis J. Gumm MD , Elizabeth B. Rand MD
{"title":"Fontan-Associated Liver Disease","authors":"Alexis J. Gumm MD , Elizabeth B. Rand MD","doi":"10.1016/j.jpeds.2024.114389","DOIUrl":"10.1016/j.jpeds.2024.114389","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114389"},"PeriodicalIF":3.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606568","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 : 2024-11-02DOI: 10.1016/j.jpeds.2024.114385
Wendy M. Brunner PhD , Zhuang Han MS , Sharon Tennyson PhD , Peter C. Fiduccia PhD, MBA, MPA , Nicole Krupa BS , Chris Kjolhede MD, MPH
Objective
To test the hypothesis that students with asthma who have access to school-based health centers (SBHCs) receive more recommended preventive care and use less emergency care, we compared patterns of health care utilization among rural students with asthma by SBHC access.
Study design
Using a cross-sectional design, we analyzed encounters for all patients ages 4 through 19 living in 4 counties covered by a health care system that sponsors a network of SBHCs in rural upstate New York. Patient addresses for each encounter were geocoded to school districts, allowing us to determine whether students lived in districts with (n = 15) or without (n = 23) a SBHC. We measured utilization among students with asthma in 2016 and 2017, comparing measures by SBHC access. Students with asthma were identified using International Classification of Diseases diagnosis codes from visits in the 2 calendar years prior to each analysis year.
Results
Students in districts with SBHCs had greater odds of 2 or more asthma-related office visits (odds ratio [OR] = 2.23; 95% CI: 1.66-2.99) and 1 or more well-child visits (OR = 1.24; 95% CI: 1.03-1.50) than their peers in districts without SBHCs. Students in districts with SBHCs had lower odds of a respiratory-related convenient care or emergency department visit (OR = 0.45; 95% CI: 0.30-0.67). Across outcomes, differences were greatest when comparing students who utilized the SBHC in their district with students in districts who did not have access to a SBHC.
Conclusions
Rural students with asthma who have access to SBHCs have greater opportunities for preventive asthma care per national guidelines and use emergency departments and convenient care less.
{"title":"Impact of Rural School-Based Health Centers on Asthma Management","authors":"Wendy M. Brunner PhD , Zhuang Han MS , Sharon Tennyson PhD , Peter C. Fiduccia PhD, MBA, MPA , Nicole Krupa BS , Chris Kjolhede MD, MPH","doi":"10.1016/j.jpeds.2024.114385","DOIUrl":"10.1016/j.jpeds.2024.114385","url":null,"abstract":"<div><h3>Objective</h3><div>To test the hypothesis that students with asthma who have access to school-based health centers (SBHCs) receive more recommended preventive care and use less emergency care, we compared patterns of health care utilization among rural students with asthma by SBHC access.</div></div><div><h3>Study design</h3><div>Using a cross-sectional design, we analyzed encounters for all patients ages 4 through 19 living in 4 counties covered by a health care system that sponsors a network of SBHCs in rural upstate New York. Patient addresses for each encounter were geocoded to school districts, allowing us to determine whether students lived in districts with (n = 15) or without (n = 23) a SBHC. We measured utilization among students with asthma in 2016 and 2017, comparing measures by SBHC access. Students with asthma were identified using International Classification of Diseases diagnosis codes from visits in the 2 calendar years prior to each analysis year.</div></div><div><h3>Results</h3><div>Students in districts with SBHCs had greater odds of 2 or more asthma-related office visits (odds ratio [OR] = 2.23; 95% CI: 1.66-2.99) and 1 or more well-child visits (OR = 1.24; 95% CI: 1.03-1.50) than their peers in districts without SBHCs. Students in districts with SBHCs had lower odds of a respiratory-related convenient care or emergency department visit (OR = 0.45; 95% CI: 0.30-0.67). Across outcomes, differences were greatest when comparing students who utilized the SBHC in their district with students in districts who did not have access to a SBHC.</div></div><div><h3>Conclusions</h3><div>Rural students with asthma who have access to SBHCs have greater opportunities for preventive asthma care per national guidelines and use emergency departments and convenient care less.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114385"},"PeriodicalIF":3.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570369","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 : 2024-11-01DOI: 10.1016/j.jpeds.2024.114383
Haihao Sun MD, PhD , Norman Stockbridge MD, PhD , D. Dunbar Ivy MD , Jennifer Clark PhD , Angela Bates MD , Stephanie S. Handler MD , Usha S. Krishnan MD , Mary P. Mullen MD, PhD , Delphine Yung MD , Rachel K. Hopper MD , Nidhy P. Varghese MD , Catherine M. Avitabile MD , Jeff Fineman MD , Eric D. Austin MD , Grace Freire MD
Objective
To investigate the feasibility of using actigraphy to measure physical activity (pA) and heart rate variability (HRV) as study endpoints in pediatric pulmonary arterial hypertension (PAH) and to compare their performance to 6-minute-walk distance (6MWD), a common primary endpoint used in PAH clinical trials in adults and children who can walk and understand the test process.
Study design
We conducted a prospective, multicenter, noninterventional study in pediatric PAH patients and healthy children. Actiheart and Fitbit Charge 2 recorded pA and heart rate data. HRV was defined as SD of daily heart rate. Actigraphy pA and HRV and 6MWD from the same subjects were analyzed to compare children with PAH with controls, and Panama functional classification (FC) III vs II. Power/sample size simulations were conducted to detect hypothetical treatment effect equivalent to differences seen between FC III and FC II.
Results
We enrolled 116 children: 90 and 98 adhered with Actiheart and Fitbit, respectively. Actigraphy daily pA was ∼36% lower (P < .05) and daily HRV was ∼18% lower (P < .05) in children with PAH (n = 62) than healthy controls (n = 54). Daily pA and daily HRV trended ∼17% lower in FC III than FC II, whereas 6MWD showed little difference. Simulation at 80% power showed that pA required 175 subjects per group and HRV required 40 per group to detect the difference/effect, whereas 6MWD required over our maximum sample size of 200.
Conclusions
Actigraphy is a feasible measure in pediatric PAH. Compared with 6MWD, pA and HRV may be more sensitive in differentiating Panama FC III from II. HRV may improve actigraphy's utility in pediatric PAH.
目的研究设计：我们对小儿肺动脉高压（PAH）患者和健康儿童进行了前瞻性多中心非介入性研究：我们对小儿 PAH 患者和健康儿童进行了一项前瞻性、多中心、非干预性研究。Actiheart™ 和 Fitbit Charge 2™ 记录了 pA 和心率 (HR) 数据。心率变异定义为每日心率的标准偏差。对同一受试者的动图 pA 和 HRV 以及 6MWD 进行了分析，以比较 PAH 儿童和对照组，以及巴拿马功能分类 (FC) III 和 II。进行了功率/样本大小模拟，以检测相当于 FC III 和 FC II 之间差异的假定治疗效果：我们招募了 116 名儿童，其中分别有 90 名和 98 名儿童坚持使用 Actiheart 和 Fitbit。Actigraphy每日pA降低了36%（PC结论：Actigraphy是一种可行的治疗方法：在小儿 PAH 中，Actigraphy 是一种可行的测量方法。与 6MWD 相比，pA 和 HRV 在区分巴拿马 FC III 和 II 方面可能更敏感。心率变异可提高动图在小儿 PAH 中的实用性。
{"title":"Actigraphy Study Endpoints to Reduce Sample Size and Facilitate Drug Development for Pediatric Pulmonary Arterial Hypertension","authors":"Haihao Sun MD, PhD , Norman Stockbridge MD, PhD , D. Dunbar Ivy MD , Jennifer Clark PhD , Angela Bates MD , Stephanie S. Handler MD , Usha S. Krishnan MD , Mary P. Mullen MD, PhD , Delphine Yung MD , Rachel K. Hopper MD , Nidhy P. Varghese MD , Catherine M. Avitabile MD , Jeff Fineman MD , Eric D. Austin MD , Grace Freire MD","doi":"10.1016/j.jpeds.2024.114383","DOIUrl":"10.1016/j.jpeds.2024.114383","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the feasibility of using actigraphy to measure physical activity (pA) and heart rate variability (HRV) as study endpoints in pediatric pulmonary arterial hypertension (PAH) and to compare their performance to 6-minute-walk distance (6MWD), a common primary endpoint used in PAH clinical trials in adults and children who can walk and understand the test process.</div></div><div><h3>Study design</h3><div>We conducted a prospective, multicenter, noninterventional study in pediatric PAH patients and healthy children. Actiheart and Fitbit Charge 2 recorded pA and heart rate data. HRV was defined as SD of daily heart rate. Actigraphy pA and HRV and 6MWD from the same subjects were analyzed to compare children with PAH with controls, and Panama functional classification (FC) III vs II. Power/sample size simulations were conducted to detect hypothetical treatment effect equivalent to differences seen between FC III and FC II.</div></div><div><h3>Results</h3><div>We enrolled 116 children: 90 and 98 adhered with Actiheart and Fitbit, respectively. Actigraphy daily pA was ∼36% lower (<em>P</em> < .05) and daily HRV was ∼18% lower (<em>P</em> < .05) in children with PAH (n = 62) than healthy controls (n = 54). Daily pA and daily HRV trended ∼17% lower in FC III than FC II, whereas 6MWD showed little difference. Simulation at 80% power showed that pA required 175 subjects per group and HRV required 40 per group to detect the difference/effect, whereas 6MWD required over our maximum sample size of 200.</div></div><div><h3>Conclusions</h3><div>Actigraphy is a feasible measure in pediatric PAH. Compared with 6MWD, pA and HRV may be more sensitive in differentiating Panama FC III from II. HRV may improve actigraphy's utility in pediatric PAH.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114383"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570368","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 : 2024-11-01DOI: 10.1016/j.jpeds.2024.114386
Shawn R. Eagle PhD, ATC , Aaron J. Zynda PhD , Lindsey Sandulli BSN, RN , Robert W. Hickey MD , Nathan E. Kegel PhD , Lindsay Nelson PhD , Michael McCrea PhD , Michael W. Collins PhD , David O. Okonkwo MD, PhD , Danny G. Thomas MD, MPH , Anthony P. Kontos PhD
Objective
To determine the step count and self-reported activity levels for obese and nonobese pediatric patients following concussion and predict self-reported symptoms, quality of life, and psychological health over time.
Study design
Participants completed the Post-Concussion Symptom Scale (PCSS), Pediatric Quality of Life (PedsQL), and Behavioral Symptom Inventory-18 (BSI-18) at an initial visit (<72 hours), 3-5 days postinjury, 10-18 days postinjury, and 1 and 2 months postinjury. Physical activity data (eg, step count) were collected via a commercial actigraph. Participants were categorized into obese and nonobese body mass index (BMI) groups based on age- and sex-adjusted growth standards. Mann-Whitney U tests compared groups while nonparametric series regression models examined the effect of obese BMI and average daily step count on PCSS, PedsQL, and BSI-18 outcomes at 1 and 2 months postinjury.
Results
One hundred ninety-four participants were included: 153 (78.9%; M = 14.6 ± 2.4 years; 50% female) in the nonobese group and 41 (21.1%; M = 14.2 ± 2.0 years; 44% female) in the obese group. The obese group had a 22.8% lower average daily step count in the week postinjury (P = .02). At 2 months, there was a significant association between obese BMI and worse PCSS total score (P = .042), PedsQL (P = .017), and BSI-18 anxiety (P = .046). Average daily step count in the first week postinjury was associated with a higher PCSS total score at 2 months (P = .031).
Conclusions
Pediatric patients following concussion with an obese BMI had a lower daily average step count in the week after injury and exhibited worse concussion symptoms, quality of life, and anxiety at 2 months compared with those with a nonobese BMI.
Trial registration
Active Injury Management (AIM) after Pediatric Concussion: NCT03869970
{"title":"The Role of Body Mass Index on Physical Activity, Symptoms, and Related Outcomes Following Pediatric Concussion","authors":"Shawn R. Eagle PhD, ATC , Aaron J. Zynda PhD , Lindsey Sandulli BSN, RN , Robert W. Hickey MD , Nathan E. Kegel PhD , Lindsay Nelson PhD , Michael McCrea PhD , Michael W. Collins PhD , David O. Okonkwo MD, PhD , Danny G. Thomas MD, MPH , Anthony P. Kontos PhD","doi":"10.1016/j.jpeds.2024.114386","DOIUrl":"10.1016/j.jpeds.2024.114386","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the step count and self-reported activity levels for obese and nonobese pediatric patients following concussion and predict self-reported symptoms, quality of life, and psychological health over time.</div></div><div><h3>Study design</h3><div>Participants completed the Post-Concussion Symptom Scale (PCSS), Pediatric Quality of Life (PedsQL), and Behavioral Symptom Inventory-18 (BSI-18) at an initial visit (<72 hours), 3-5 days postinjury, 10-18 days postinjury, and 1 and 2 months postinjury. Physical activity data (eg, step count) were collected via a commercial actigraph. Participants were categorized into obese and nonobese body mass index (BMI) groups based on age- and sex-adjusted growth standards. Mann-Whitney <em>U</em> tests compared groups while nonparametric series regression models examined the effect of obese BMI and average daily step count on PCSS, PedsQL, and BSI-18 outcomes at 1 and 2 months postinjury.</div></div><div><h3>Results</h3><div>One hundred ninety-four participants were included: 153 (78.9%; M = 14.6 ± 2.4 years; 50% female) in the nonobese group and 41 (21.1%; M = 14.2 ± 2.0 years; 44% female) in the obese group. The obese group had a 22.8% lower average daily step count in the week postinjury (<em>P</em> = .02). At 2 months, there was a significant association between obese BMI and worse PCSS total score (<em>P</em> = .042), PedsQL (<em>P</em> = .017), and BSI-18 anxiety (<em>P</em> = .046). Average daily step count in the first week postinjury was associated with a higher PCSS total score at 2 months (<em>P</em> = .031).</div></div><div><h3>Conclusions</h3><div>Pediatric patients following concussion with an obese BMI had a lower daily average step count in the week after injury and exhibited worse concussion symptoms, quality of life, and anxiety at 2 months compared with those with a nonobese BMI.</div></div><div><h3>Trial registration</h3><div>Active Injury Management (AIM) after Pediatric Concussion: NCT03869970</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114386"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570370","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 : 2024-10-30DOI: 10.1016/j.jpeds.2024.114376
J. Wells Logan MD , Xiaodan Tang PhD , Rachel G. Greenberg MD , Brian Smith MD , Lisa Jacobson ScD , Courtney K. Blackwell PhD , Mark Hudak MD , Judy L. Aschner MD , Barry Lester PhD , T. Michael O'Shea MD
Objectives
To evaluate positive health outcomes among children born at < 32 weeks of gestation and to determine whether children with three common neonatal morbidities and 2 neurodevelopmental impairments would have similar positive health outcomes to children and adolescents without these exposures and impairments.
Study design
In this secondary analysis of prospectively acquired data derived from 3 multicenter cohorts of children born very preterm (the Extremely Low Gestational Age Newborn cohort [birth years 2001 to 2004], the Neurobehavior And Outcomes in Very Preterm Infants cohort [birth years 2014 to 2016], and the Developmental Impact of Neurobehavior And Outcomes in Very Preterm Infants Exposures cohort [birth years 2010 to 2020]), we examined associations between the 3 common neonatal morbidities (bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage, diagnosed before hospital discharge), 2 neurodevelopmental impairments (developmental delays and cerebral palsy, diagnosed at preschool age follow-up), and perceptions of physical, mental, and social well-being (in either early childhood or adolescence), using the Patient-Reported Outcomes Measurement Information System scales for positive health.
Results
After adjusting for confounders, bronchopulmonary dysplasia, intraventricular hemorrhage, and cerebral palsy were associated with lower positive health scores, reported by parent-proxy during early childhood. None of the exposures or impairments were associated with lower positive health scores at adolescence, reported by the children themselves.
Conclusion
Parents of children born very preterm with bronchopulmonary dysplasia, intraventricular hemorrhage, or cerebral palsy rated their children's positive health lower than did parents of children without these morbidities. However, adolescents' own reports of positive health outcomes were not associated with either neonatal pre-discharge morbidities or preschool neurodevelopmental impairments.
{"title":"Neonatal Morbidities, Neurodevelopmental Impairments, and Positive Health among Children Surviving Birth before 32 Weeks of Gestation","authors":"J. Wells Logan MD , Xiaodan Tang PhD , Rachel G. Greenberg MD , Brian Smith MD , Lisa Jacobson ScD , Courtney K. Blackwell PhD , Mark Hudak MD , Judy L. Aschner MD , Barry Lester PhD , T. Michael O'Shea MD","doi":"10.1016/j.jpeds.2024.114376","DOIUrl":"10.1016/j.jpeds.2024.114376","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate positive health outcomes among children born at < 32 weeks of gestation and to determine whether children with three common neonatal morbidities and 2 neurodevelopmental impairments would have similar positive health outcomes to children and adolescents without these exposures and impairments.</div></div><div><h3>Study design</h3><div>In this secondary analysis of prospectively acquired data derived from 3 multicenter cohorts of children born very preterm (the Extremely Low Gestational Age Newborn cohort [birth years 2001 to 2004], the Neurobehavior And Outcomes in Very Preterm Infants cohort [birth years 2014 to 2016], and the Developmental Impact of Neurobehavior And Outcomes in Very Preterm Infants Exposures cohort [birth years 2010 to 2020]), we examined associations between the 3 common neonatal morbidities (bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage, diagnosed before hospital discharge), 2 neurodevelopmental impairments (developmental delays and cerebral palsy, diagnosed at preschool age follow-up), and perceptions of physical, mental, and social well-being (in either early childhood or adolescence), using the Patient-Reported Outcomes Measurement Information System scales for positive health.</div></div><div><h3>Results</h3><div>After adjusting for confounders, bronchopulmonary dysplasia, intraventricular hemorrhage, and cerebral palsy were associated with lower positive health scores, reported by parent-proxy during early childhood. None of the exposures or impairments were associated with lower positive health scores at adolescence, reported by the children themselves.</div></div><div><h3>Conclusion</h3><div>Parents of children born very preterm with bronchopulmonary dysplasia, intraventricular hemorrhage, or cerebral palsy rated their children's positive health lower than did parents of children without these morbidities. However, adolescents' own reports of positive health outcomes were not associated with either neonatal pre-discharge morbidities or preschool neurodevelopmental impairments.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114376"},"PeriodicalIF":3.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559479","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：