Pediatrics and Neonatology最新文献

Background: Congenital pyloric atresia (CPA) is an extremely rare neonatal gastric outlet obstruction (approximately 1 in 100,000 live births) that requires prompt surgical correction. It can occur in isolation or in association with junctional epidermolysis bullosa (JEB), and historically it has been managed with open surgery. Laparoscopic repair has only been reported in a few cases, so its safety and efficacy remain unclear.

Methods: We retrospectively reviewed five paediatric patients with Type I CPA (pyloric web) who were treated laparoscopically at three centers between 2020 and 2024. Patients' ages ranged from 2 days to 15 months (four neonates and one older infant). Data on clinical presentation, diagnostic work-up, surgical technique, and outcomes were collected from medical records and follow-up interviews.

Findings: All five patients underwent successful laparoscopic pyloric web resection and Heineke-Mikulicz pyloroplasty, with no conversions to open surgery. There were no intraoperative complications. One neonate (who had severe hypoxic-ischaemic encephalopathy) died of unrelated causes, whereas the remaining four patients recovered well. Full oral feeds were achieved within one week postoperatively in all survivors. At 1-5 years of follow-up, all four surviving children were thriving with normal growth and no recurrent obstruction. Notably, the 15-month-old infant in our series illustrates that a small perforated pyloric web can initially evade diagnosis; however, targeted imaging eventually confirmed the gastric outlet obstruction.

Interpretation: In this case series, laparoscopic management of CPA proved feasible, safe, and effective in experienced paediatric surgical centers. The minimally invasive approach achieved outcomes comparable to those historically reported for open surgery. Early clinical recognition and appropriate imaging are critical for timely diagnosis, especially in partial or intermittent obstructions. Where surgical expertise and equipment are available, laparoscopy may be the preferred first-line treatment for Type I pyloric atresia, offering a definitive cure with minimal invasiveness.

Objectives: To investigate the effects of Bifidobacterium breve strain Yakult (BbrY) administration immediately after birth on the microbiome of cesarean-born full-term infants with an immature microbiota at birth.

Methods: This single-center, placebo-controlled, randomized, double-blind, parallel-group intervention study included healthy, full-term Japanese infants born via planned cesarean section. Infants were administered either BbrY or placebo for the first month of life. The primary endpoint was the early establishment of a Bifidobacterium-dominant microbiome.

Results: This study included 26 infants (14 in the BbrY group and 12 in the placebo group). Compared with the placebo group, the BbrY group showed significantly increased detection rates and counts of BbrY from day three to six months post-birth, with the level and proportion of Bifidobacterium and Bifidobacteriaceae remaining elevated until one month post-birth. Total bacterial counts and total organic acid concentrations, including acetic and lactic acids, were significantly higher in the BbrY group until the sixth day of life, concomitant with a decrease in fecal pH. At nine months, the BbrY group exhibited a significantly higher body weight than the placebo group, and the Kaup index remained within the normal range at six and nine months.

Conclusions: BbrY supplementation immediately after birth facilitated the early establishment of a Bifidobacterium-dominant microbiome and contributed to intestinal acidification in cesarean-born infants, indicating BbrY administration may support normal growth patterns during infancy.

Background: Bronchopulmonary dysplasia (BPD) is a prevalent respiratory disorder in premature infants. Recent studies have revealed an association between the intestinal microbiome and respiratory diseases. This study aims to explore the characteristics of the gut microbiome of premature infants with moderate and severe BPD.

Methods: The study population consisted of preterm infants with a gestational age of ≤34 weeks. Infants with moderate and severe BPD were selected as the case group. Stool samples were collected at birth and 28 days after delivery. The obtained samples were processed using 16sRNA technology for diversity analysis, taxonomic composition, and LEfSe analysis.

Results: In this study, 15 infants were enrolled in the BPD group, while 15 infants were included as controls. At birth, the alpha diversity of the BPD group was significantly lower compared to the control group. Infants with severe BPD had even lower diversity. The relative abundance of Staphylococcus in the BPD group was higher, whereas Sphingomonas and Veillonella were the predominant species in the control group. Additionally, the severe BPD group exhibited a higher abundance of Bacillales and Oscillospiraceae compared to the moderate BPD group. At 28 days after birth, there was an increase in the abundance of Escherichia, Klebsiella, and Bifidobacterium compared with previous levels, and a decrease in the abundance of Herbaspirillum.

Conclusions: The diversity of intestinal microbiota in infants with moderate and severe BPD appears to be relatively lower, and specific microbial species such as Staphylococcus and Bacillales may contribute to the pathogenesis and progression of BPD. The intestinal microbiota in infants with BPD interacts with the oxygen environment in the gut, and its early formation is influenced by maternal factors. These findings regarding the diversity and specific flora of gut microbiota could potentially offer insights into the pathogenesis of BPD.

Background: Families and healthcare providers of sick newborns or periviable extremely preterm infants in NICUs sometimes need to make ethical decisions regarding the withdrawal or withholding of life-sustaining treatments. Although international variations have been reported, data from other Asian countries are limited. This study assesses this topic in Asia.

Methods: A web-based questionnaire survey was sent to the representatives of 408 NICUs in neonatal networks across eight Asian countries (Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, and Thailand). The five questions asked how often the facility provided life-sustaining treatment for certain newborn scenarios with potentially poor prognosis. The answer options were "routinely" (90-100% of cases), "often" (50-89%), "sometimes" (10-49%), "rarely" (1-9%), and "never" (0-1%). The results were summarized as percentages of answers given.

Results: A total of 310/408 NICUs (76%) across Asian countries responded to the survey. The proportion of facilities that "routinely" or "often" provided withdrawal of life-sustaining treatment for bilateral intraventricular hemorrhage varied widely among the networks (0%-100%). Higher proportions of facilities from Japan (44%) and South Korea (33%) "routinely" provided active resuscitation to infants born at 22 weeks gestation compared with those from other countries (0-20%). The proportion of facilities that actively resuscitated infants born at 23, 24, and 25 weeks gestation in each network ranged from 0 to 85%, 9-100%, and 28-100%, respectively. For infants born at 26 weeks gestation or more and those with a birth weight of 600 g or more, the majority of facilities (≥60%) "routinely" provided active resuscitation in all countries.

Conclusions: Ethical decisions varied widely among Asian countries, especially for infants born at 22-25 weeks gestation.

Background: Severe and persistent pulmonary hypertension (PH) predicts mortality and short-term pulmonary morbidity in infants with congenital diaphragmatic hernia (CDH). Intrathoracic liver herniation (liver-up) is a predictor of survival and increased need for extracorporeal membrane oxygenation. There is a paucity of data on the timeline of PH resolution in infants with and without liver herniation. We aim to determine the time to PH resolution in infants with liver-up and liver-down CDH, and to describe the resource utilization among these infants.

Methods: We conducted a retrospective study of CDH infants in a quaternary neonatal intensive care unit between January 2018 and March 2021 who received targeted neonatal echocardiography (TnEcho). Our primary outcome of PH resolution was defined echocardiographically by left-to-right shunting at the patent ductus arteriosus (PDA) or rounded interventricular septum on parasternal short axis view if the PDA was closed. Serial TnEcho assessments were performed every 1-2 days around the perioperative period and then every 2-3 weeks as clinically indicated.

Results: Nineteen CDH infants were evaluated, of which 9 (47.4 %) infants were in the liver-up group. Baseline characteristics such as birth weight, gestational age, and sex were comparable in both groups. The median time to PH resolution was prolonged among infants with liver herniation (20.5 vs. 11.5 days, p = 0.005). The median length of stay and invasive ventilation days were longer in liver-up group (113 vs. 31 days, p = 0.017) and (19 vs. 7.5 days, p = 0.033), respectively. The proportion of infants demonstrating tube dependence for feeding at discharge was higher in the liver-up group compared with the liver-down group (8 [88.9 %] vs. 2 [20.0 %], p = 0.005).

Conclusion: CDH infants with liver herniation experience a delayed resolution of pulmonary hypertension. Furthermore, these infants require longer hospitalization and more days on invasive ventilation.