Acta Paediatrica最新文献

Aim: Pulmonary hypertension is frequent in neonates with a congenital diaphragmatic hernia, but long-term data have been scarce. Our aim was to examine its prevalence, evolution and management and identify factors associated with its persistence.

Methods: This French retrospective cohort study compared the characteristics of neonates who had persistent pulmonary hypertension, or died with it, and those with normalised pulmonary pressures at 1 month and 1 year of age.

Results: Most (92%) of the 88 neonates we studied underwent surgery. Two-thirds (67%) had preoperative pulmonary hypertension and they included 10 of the 11 who died after surgery. Pulmonary hypertension resolved after a median of 31 days in the 70 who were discharged alive and 27% required prolonged sildenafil treatment. At 1 year, 6 (9%) of the 65 children with echocardiographic data available still had elevated pulmonary pressures. Preoperative pulmonary hypertension, associated malformations and longer invasive ventilation were independently associated with persistent pulmonary hypertension at 1 month. Only prolonged invasive ventilation remained significant at 1 year.

Conclusion: Despite its high initial prevalence and impact on mortality, pulmonary hypertension resolved within weeks of surgery in the surviving neonates. The duration of invasive ventilation may have been a key factor in its persistence.

Aim: This study examined (i) whether the amount of audiovisual media exposure predicts child language use, language input and language interaction, and (ii) the role of the media programme type (child-oriented educational, child-oriented entertainment, adult-oriented) in relation to parent-child language.

Methods: Using Language Environment Analysis (LENA) recorders, we collected day-long language recordings in homes of families with children in the U.S. Human coding of entire recordings was used to capture the amount of total media exposure and programme type for child language environment. Automated measures of language (child vocalisations, adult word count, conversational turns) were obtained from LENA recordings. The study included 29 children (12 girls [41.38%]; mean [SD] age 25.28 months [3.01]).

Results: Regression analyses showed that higher total audiovisual media time was associated with lower child language use, language input and language interaction. Higher child-oriented entertainment media time was also associated with lower child language use, language input and language interaction, while adult-oriented media time was associated with lower child language use and language interaction.

Conclusion: It is recommended that practitioners communicate the importance of caregiver-child interactions as well as media timing and content management to families with young children.

Aim: Mastering echocardiography scans is essential in neonatology, but bedside training can be difficult due to the instability of neonatal patients. The aim of this study was to demonstrate the benefits of simulation-based training for residents learning echocardiography.

Methods: This multicentre randomised controlled trial involved residents from three French neonatology departments. The authors compared a control group with theoretical and bedside training and a simulation group with additional simulation-based training. Evaluations were conducted three and 6 months after training using two scoring methods: a reference score for the quality of the echocardiographic sections and a custom-made score for recognising anatomical structures.

Results: We randomised 52 residents from 1 May 2021 to 31 May 2023. After 3 months, the residents in the simulation group achieved a higher mean score than the residents in the control group for both the reference score (11.5 ± 2.3 points vs. 7.4 ± 3.4 points, p < 0.001) and the custom-made score (25.8 ± 5.3 points vs. 16.9 ± 7.8 points, p < 0.001). The difference remained significant at 6 months and the custom-made score showed good agreement with the reference score.

Conclusion: Simulation-based training was a valuable approach for training neonatal residents to perform echocardiography and more extensive training courses should be developed.

Trial registration: ClinicalTrials.gov identifier: NCT06442683.

Aim: Timeline of atherosclerosis in children with type 1 diabetes is unknown. We aimed to investigate if familial risk of type 1 diabetes is associated with pro-atherosclerotic changes.

Methods: Young first-degree relatives to patients with paediatric type 1 diabetes and sex and age matching controls were enrolled at Skåne University Hospital, Sweden between 2006 and 2015. Conventional lipids, human leukocyte antigen DQ2/8, inflammatory biomarkers, and history of respiratory infections were determined.

Results: A total of 117 first-degree relatives and 43 controls were recruited (50% boys) at median of 13.4 years of age (IQR 8.0). Relatives had lower BMI Z-score (p = 0.03) and frequency of respiratory infections (p = 0.03) compared to controls, but higher low-density lipoprotein (LDL, p = 0.04) and total cholesterol (p = 0.01). In multivariable regression models adjusted for confounders LDL was 0.35 mmol/L higher (95% CI 0.10-0.61) and total cholesterol was 0.46 mmol/L higher (95% CI 0.15-0.77) in relatives. Relatives with ≥ 4 respiratory infections/year had higher LDL than controls with < 4 infections/year (p = 0.035). Human leukocyte antigen DQ2/8 frequency and inflammatory biomarkers did not differ between groups.

Conclusion: Healthy young relatives to patients with type 1 diabetes display adverse lipid changes, probably related to their genetic susceptibility to this disease and recent respiratory infections.

Aim: Transient hypothyroxinemia of prematurity (THOP) has been associated with suboptimal neurodevelopment. We aimed to assess neurodevelopment in very preterm infants with treated and untreated THOP.

Methods: This study was a multicentre, cohort study, based on prospectively collected data in four French level III neonatal intensive care units. Infants born before 32 weeks of gestation between 2009 and 2020 who underwent a thyroid function test were included. THOP was defined as low free thyroxine and unelevated thyroid stimulating hormone. Infants were classified as no THOP, treated THOP, and untreated THOP. The primary outcome was suboptimal neurodevelopment at 2 years of age evaluated by clinical examination.

Results: Three hundred and seventy-three infants (54% male) born at a median gestational age of 28 weeks of gestation were included. There was no significant difference in neurodevelopment at 2 years of age when comparing the no THOP to the THOP group (Odds Ratio (OR) 1.4, 95% confident Interval (CI) 0.8-2.3) nor when comparing the treated with the untreated THOP group (OR 0.8, 95% CI 0.3-1.9). Results remained unchanged after adjusting for confounding factors.

Conclusion: In very preterm infants treated THOP was not associated with improved neurodevelopment compared to untreated THOP. Numerous biases could have limited treatment effect.

Aim: The differences between parent-child joint attention while reading together from a screen versus from a paper are unknown. The current study aimed to determine if parent-child brains synchronise differently during screen-based versus printed paper-based, in other words, a book reading.

Methods: The study was carried out in 2022 in Israel. Cohorts were recruited via posted ads. Cognitive and behavioural measures were assessed using standardised tests. In addition, two reading sessions were administered by the parent, one on the screen and another using a book, while electroencephalograph data captured their brain synchronisation. The difference in brain synchronisation between the conditions was correlated with behavioural measures.

Results: Of the 49 parent-child pairs age 3.94 years ± 0.751; 24 females who participated in language-based tasks for this study, electroencephalograph data from 11 dyads showed a higher brain-to-brain synchronisation during printed-based reading compared to screen-based reading was found and associated with the child's verbal and cognitive abilities.

Conclusion: Printed-paper reading fosters a higher parent-child neural synchronisation and cognitive engagement compared to screen-based reading.

Congenital heart disease (CHD) includes defects of intrauterine cardiac development that result in alterations to the morphology and/or physiology of the heart, usually expressed early in fetal or postnatal life. This group represents one of the most common congenital anomalies of all living newborns worldwide. Neurodevelopmental deficits are a reality in patients with CHDs and may contribute to significant sequela and long-term morbidity beginning in infancy and extending into adulthood. There is general agreement that the perioperative period of neonatal cardiac surgery may be responsible for a significant burden of lifelong neurological injury in patients with CHDs. Recent research has advanced understanding of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for patients with these disorders. In the present study, we aim to describe the different emerging strategies for neuroprotection in the perioperative period in neonatal patients with congenital heart disease.

Aim: This study hypothesised that infants with a haemodynamically significant patent ductus arteriosus (hsPDA) as defined by a validated score have a higher incidence of acute kidney injury (AKI).

Methods: A retrospective study was conducted including infants < 29 weeks' gestation, born at the Rotunda Hospital. The El-Khuffash patent ductus arteriosus (PDA) severity score was applied following an echocardiographic assessment. Mann Whitney-U and χ² tests were utilised to assess for association with AKI.

Results: We report a cohort of n = 86 infants with PDA of a mean (standard deviation) gestation of 27 (1) weeks and birth weight of 957 g (235 g). Ten (11.6%) of infants developed AKI. Birth weight, gestation, death-by-discharge, high-risk PDA score, PDA treatment, and ibuprofen receipt were associated with AKI. The presence of a high-risk PDA score was independently associated with the occurrence of AKI. Therapeutic intervention and ibuprofen use proved significant in their associations with AKI.

Conclusion: A high-risk El-Khuffash PDA score is predictive of AKI in our cohort. Ductal diameter in isolation is ineffective as a measure of haemodynamic significance in the context of AKI prediction. Both PDA treatment and ibuprofen-use are associated with an increased risk of AKI. Further work to validate the use of this score for AKI prediction is warranted.