Pediatrics and Neonatology最新文献

Background: Uterine volume (UV) and bone age (BA) are important determinants for evaluating the pubertal status of growing girls. However, the correlation between these two parameters in growing children has not yet been fully investigated.

Methods: This retrospective observational study collected data from girls aged 1-14 years who were classified into precocious puberty (PP) and normal puberty (NP) for subgroup analysis. The demographic data, BA, and UV were thoroughly analyzed to elucidate their associations.

Results: A total of 542 girls were enrolled in the study from 2013 to 2022. The PP group had a slightly higher height-SDS (p = 0.175) and significantly higher weight-SDS (p < 0.019) compared with the NP group. Although the inflection point of increased mean UV was the same at the age of 9 in PP (8 yrs: 3.15 cm³; 9 yrs: 5.7 cm³) and NP groups (8 yrs: 2.98 cm³; 9 yrs: 6.06 cm³), a dramatically increasing trend of UV was noticed in PP girls. Compared with chronological age (CA), BA showed a more significant correlation with UV (r²=0.491 in PP, r²=0.515 in NP, both p < 0.01).

Conclusions: This study provides the reference ranges of UV, which are not only based on CA and BA but which also considered both PP and NP statuses. Different references of UV are recommended when evaluating growing children in view of diverse onset ages of puberty.

Background: We assessed the newborns' intestinal microbiota during the first three weeks of life using molecular biology techniques to understand colonization patterns according to feeding type.

Methods: We conducted a prospective, observational descriptive study at the National Reference Centre for Neonatology and Nutrition, in collaboration with the research laboratory of the Children's Hospital at the University Hospital Centre Ibn Sina in Rabat. Stool samples were collected from 29 preterm newborns upon admission to the neonatal unit and subsequently twice weekly over a three-week period. Microbial composition was analyzed using real-time polymerase chain reaction (RT-qPCR), targeting four phyla: Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria.

Results: The gestational age of the included preterm infants ranged from 28 to 36 weeks of amenorrhea. Enteral nutrition was initiated between the second and sixth days after birth. None of the infants was nursed immediately after birth or during their hospitalization. However, in 79 % of cases, breast milk was collected at home for later use in feeding the newborns, and among these, 21 % received more than 50 % of the collected breast milk. Over the first two weeks of life, Lactobacillus spp. was only detected in infants nursed by both breast milk and formula milk. Enterococcus spp. was present in all breastfed infants. Clostridium difficile and Clostridium perfringens were found in 83 % of formula-fed newborns in the second week of life and in all newborns by the end of the third week.

Conclusion: Promoting breastfeeding whenever possible is crucial for fostering a healthy gut microbiota. When breastfeeding is not feasible, incorporating infant formulas supplemented with probiotics and/or prebiotics can help establish a microbiota similar to that of breastfed infants. Additional preventive strategies, such as vaginal or fecal microbiota transplantation, may be considered, particularly for infants born via caesarean section.

Background: Very-low-birth-weight infants (VLBWIs) are at risk of extrauterine growth restriction (EUGR), which is associated with poor neurodevelopmental outcomes. This study aimed to determine the incidence of EUGR in VLBWIs and the factors associated with EUGR using a longitudinal definition.

Methods: Data of infants with birth weights <1500 g admitted to a university hospital in Tokyo were collected from medical records. Longitudinal EUGR was defined as a loss of weight and head circumference exceeding one standard deviation score between birth and 36 weeks of postmenstrual age.

Results: In total, 334 VLBWIs participated in this study. Longitudinal EUGR incidence for weight and head circumference were 31.4 % and 38.3 %, respectively. In the multivariate analysis, significant risk factors for longitudinal EUGR based on weight and head circumference were congenital heart disease and a greater number of days to reach 150 ml/kg/day by enteral feeding.

Conclusions: This study was the first to demonstrate that congenital heart disease was associated with EUGR using a longitudinal definition. Furthermore, the rate of increase in volume of enteral feeding was crucial for VLBWIs to maintain growth rates during hospitalization.

Background: Data on the development of immune, hematologic, and lung function in preterm infants beyond the early postnatal period are limited. This study aimed to determine whether these systems in preterm infants mature to levels comparable to full-term infants by one year of age.

Methods: Toll-like receptor (TLR)-induced cytokine responses, prevalence of iron deficiency anemia, and infant lung function (ILFT) measurements were investigated in premature and full-term infants at 1 year of age.

Results: By the corrected age of 1 year, the prevalence of iron deficiency anemia was comparable between full-term (18.4 %) and preterm infants (22.7 %). However, preterm infants exhibited lower IL-6 and IL-10 responses to TLR7/8 and phytohemagglutinin stimulation compared to their full-term counterparts. While ILFT measurements showed no significant overall differences, infants born before 34 weeks of gestation had lower tidal volumes than late-preterm and full-term infants (p < 0.031).

Conclusion: There was no significant difference in the prevalence of anemia between full-term and preterm infants. However, preterm infants, especially those born before 34 weeks of gestation, may continue to show unique immunologic and pulmonary function profiles beyond infancy. These findings highlight the need for ongoing monitoring of preterm infants to address their unique health challenges.

Objective: This study aims to explore the ABO-dependent mechanism of ADAMTS13-mediated VWF cleavage in neonatal thrombocytopenia (NTP) during platelet transfusion.

Methods: Plasma VWF in AA, BB, OO, AO, BO group from NTP patients was measured by ELISA kit. Blood-derived VWF samples from NTP patients from February 2020 to December 2022 were divided according to ABP blood group, followed by incubation with the recombinant ADADMTS13 in static state or high-shear stress. Also, VWF from NTP patients was mixed with platelet suspension from healthy adults with alloantigen of ABO phenotype, followed by the digestion of rADAMTS13 in static state or high-shear stress. The VWF cleavage (176 kDa) was detected by western blot combined with non-reactive SDS-PAGE.

Results: Compared to OO group, plasma VWF in BO, AO, BB and AA increased successively. Both in static state and high-shear stress condition, the cleavage of NTP-derived VWF decreased in the following order: OO, BO, AO, BB and AA. Importantly, the cleavage of NTP-VWF in all ABO blood groups was increased in high-shear stress as compared to that in static state. With incubation with platelet suspension, the ADAMTS13-induced VWF cleavage decreased in the following order: OO, BO, AO, BB and AA in both static state and in high-shear stress condition. Also, exogenous VWF from platelet suspension increased VWF cleavage in all blood groups.

Conclusion: The VWF susceptibility to ADAMTS13 proteolysis was increased as follows: A, B and O blood phenotype during platelet transfusion, causing imbalance of neonatal hemostasis in an ABO-dependent manner.

Osteopontin, also referred to as bone sialoprotein I or secreted phosphoprotein 1, is a multifunctional glycoprotein implicated in numerous physiological and pathological processes. Initially identified in the early 1980s in osseous tissue, OPN plays a critical role in biomineralization and bone remodeling. It is expressed in a wide range of tissues and exerts its biological effects through binding to integrins and CD44 receptors on target cell surfaces, thereby modulating intracellular signaling pathways involved in immune regulation and inflammatory responses. Functionally, OPN acts as a cytokine that mediates cell-matrix interactions, facilitating cell adhesion, migration, and immune cell activation. Recent studies have proposed that the inclusion of OPN in infant formula may confer immunological and gastrointestinal benefits comparable to those observed in breastfed infants. Consequently, OPN is being investigated as a functional ingredient to enhance the nutritional and developmental efficacy of infant formula. While exclusive breastfeeding remains the gold standard for infant nutrition and developmental support, OPN-fortified formula may serve as a viable alternative when breast milk is unavailable or insufficient.

Background: Eosinophilia is frequently observed in preterm infants. However, little is known about trends in eosinophil counts in periviable infants. This study aimed to describe eosinophil count trends in infants born at 22-24 weeks of gestation during the neonatal period compared with infants born at 25-28 weeks of gestation.

Methods: This single-center retrospective cohort study included neonates born between 22 + 0 and 28 + 6 weeks of gestation without congenital anomalies from 2013 to 2022 at our hospital. We described eosinophil count trends in infants born at 22-24 weeks of gestation from birth to 12 weeks of age and compared the trend with those of infants born at 25-28 weeks of gestation. Multiple regression analysis was performed to determine the peak eosinophil counts and potential confounders.

Results: A total of 124 infants were analyzed. Eosinophilia (≥700 eosinophils/mm³) was observed in 41/42 (97.6 %) infants born at 22-24 weeks of gestation. Eosinophil counts peaked when the infants were 3-4 weeks of age; this trend did not differ from that in infants born at 25-28 weeks of gestation. Peak eosinophil counts were significantly higher in infants born at 22-24 weeks of gestation. Gestational age and birth weight were negatively associated with peak eosinophil counts (Spearman's rank correlation coefficient [r] = -0.23; p = 0.011 and r = -0.30; p < 0.001, respectively). Clinical parameters were not associated with peak eosinophil counts in infants born at 22-24 weeks of gestation after adjusting for gestational age and birth weight.

Conclusion: A significantly higher proportion of infants born at 22-24 weeks of gestation exhibited eosinophilia compared to infants born at 25-28 weeks of gestation; however, both groups of infants had similar peak eosinophilia timing. These results will prompt further studies exploring eosinophilia of prematurity mechanism in this population.

Aim: Predicting motor outcomes in hypoxic-ischaemic encephalopathy (HIE) is challenging. We aimed to assess the value of the four-month Alberta Infant Motor Scale (4M-AIMS) in predicting motor development at 18 months of age.

Method: A retrospective cohort study was conducted at Sainte-Justine University Hospital Centre (Canada), including patients with hypoxic-ischemic encephalopathy (HIE) who underwent therapeutic hypothermia between 2009 and 2016. Neurodevelopmental follow-ups were conducted at two and four months with the AIMS, and motor outcomes were classified at 18 months according to the Gross Motor Function Classification System. Ordinal regression was used to assess the predictive value of AIMS scores and brain MRI for motor outcome.

Results: Of the 52 newborns included: 16 children (31 %) had normal motor development, 25 (48 %) displayed motor delays, and 11 patients (21 %) had cerebral palsy. Forty-one (79 %) infants had an abnormal 4M-AIMS score (below the 10th percentile). Early brain MRI and 4M-AIMS scores were both predictive of altered motor outcomes (χ² = 6.1, p-value = 0.013 and χ² = 4.9, p-value = 0.029, respectively). A normal four-month AIMS assessment is considered a reliable indicator for excluding a future cerebral palsy.

Interpretation: Complementary assessment with brain MRI and 4M-AIMS with a score below the 0th percentile provides accurate prediction of motor outcomes at 18 months.

Short title: Cerebral Palsy predictive value of AIMS.

Background: For preventing Vitamin D (VD) insufficiency, several VD supplementation guidelines were established worldwide. In Japan, no nationwide guidelines for preventing VD insufficiency have been implemented, whereas guidelines for preventing vitamin K (VK) deficiency-related bleeding recommend weekly supplementation of VK. The aim of this study is to clarify whether weekly VD plus VK supplementation during the early neonatal period prevents VD insufficiency at one month of age.

Methods: We retrospectively analyzed serum 25-hydroxyvitamin D (25(OH)D) levels of 555 one-month-old infants born between 2017 and 2023. Infants were classified into the control group (not supplemented), weekly group (1000 IU/week), and daily group (240 IU/day). We compared serum 25(OH)D levels among the three groups. Multivariable logistic regression analyses adjusted for formula intake and BMI were performed to better estimate the effect of VD supplementation on the prevention of VD insufficiency.

Results: We included 414, 55, and 86 infants in the control, weekly, and daily groups, respectively. All infants received weekly supplementation of VK. Serum 25(OH)D levels in the weekly and daily groups were higher than those in the control group (median (ng/mL): control 9.7 vs weekly 22.2, P < 0.001; control vs daily 23.0, P < 0.001). The frequencies of VD insufficiency were 370/414 (89.4 %), 11/55 (20.0 %), and 22/86 (25.6 %) in the control, weekly, and daily groups, respectively. Adjusted odds ratios of VD insufficiency compared to the control were 0.038 (95 % confidence intervals (95 %CI): 0.017, 0.085) and 0.036 (95 %CI: 0.019, 0.067) in the weekly and daily groups, respectively. No infant with VD excess was observed.

Conclusion: Our results demonstrated that combined weekly supplementation of VD and VK during early infancy can prevent VD insufficiency at one month of age without causing VD excess. This finding may provide evidence for the development of nationwide prophylaxis for VD insufficiency in regions lacking specific guidelines.