Pediatrics and Neonatology最新文献

Background: Neonatal abstinence syndrome (NAS) encompasses symptoms that are observed in neonates exposed to psychotropic drugs in utero. Although NAS associated with opioid exposure has been well studied, the risk of NAS related to maternal psychotropic medication use remains underexplored. The aim of this study was to examine the association between maternal psychotropic medication use and NAS incidence in neonates born to mothers with psychiatric disorders.

Methods: A retrospective cohort study was conducted at the Kagoshima University Hospital between January 2021 and December 2023. Maternal and neonatal data, including psychotropic medication exposure, were collected. NAS was assessed using the Finnegan score extracted from medical records.

Results: Among the 132 neonates studied, 27 (20.5 %) developed NAS. Significant predictors of NAS included maternal use of antipsychotics, anxiolytics, and hypnotics. NAS severity showed weak positive correlations with the number and index of psychotropic medications. The most accurate predictive model combined the psychotropic medication index with the 1-min Apgar score (area under the receiver operating characteristic curve = 0.860).

Conclusions: Maternal psychotropic medication use is significantly associated with NAS development. Although the predictive model showed promising accuracy, it is important to interpret these findings with caution due to the retrospective design of the study and the relatively mild NAS severity. Integrating pharmacological and clinical data may assist in identifying neonates at risk; however, further validation is warranted.

Background: Neonatal sepsis is a critical health concern that demands accurate and timely diagnosis. Blood culture, the gold standard, is challenging in extremely low birth weight (ELBW) infants because of the limited blood volume and potential aerobic culture limitations. The VersaTREK (Thermo Fisher Scientific, Waltham, MA, USA) blood culture system, which requires less blood and offers both aerobic and anaerobic cultures, presents a potential solution. This study aimed to compare the diagnostic performance with the widely used BD (Becton Dickinson, Franklin Lakes, NJ, USA) blood culture systems for neonatal sepsis patients.

Methods: We conducted a three-step study, including in vitro testing of common pathogens, prospective observational cohort data from a neonatal intensive care unit (NICU), and a head-to-head comparison. VersaTREK's blood culture bottles include aerobic and anaerobic media, whereas BD uses a specialized bottle for aerobic cultures.

Results: In phase 1 of this in vitro comparison study, VersaTREK outperformed BD, particularly at low bacterial loads. In phase 2, a prospective observational cohort analysis revealed a significantly greater yield with VersaTREK, especially for gram-positive cocci and gram-negative bacteria. In phase 3, a head-to-head comparison demonstrated comparable performance between the two systems, with potential advantages for VersaTREK in scenarios involving minimal blood volumes, as little as 0.1 mL.

Conclusions: The VersaTREK and BD blood culture systems demonstrated similar diagnostic performance, with VersaTREK capable of detecting as little as 0.1 mL of blood. While this is promising in scenarios with minimal blood volume, further investigations with larger sample sizes are needed.

Background: Bronchopulmonary dysplasia (BPD) is a common early-onset and long-term lung disorder in premature infants. Although miRNAs serve as validated biomarkers for prognostic assessment, their translational potential in BPD management via the miR-93-5p/TNFRSF21 pathway remains underexplored. This investigation sought to examine the association of miR-93-5p expression with BPD progression and to explore its regulatory mechanism in BPD. It aimed to identify potential biomarkers for clinical prevention and diagnosis of BPD and offer new treatment ideas.

Methods: Clinical data from 87 BPD and 70 non-BPD patients were analyzed. RT-qPCR assessed expression, with correlation and multiple logistic regression analyses. Human alveolar epithelial cell hyperoxia-induced injury models evaluated miR-93-5p expression, proliferation, apoptosis, inflammation, and oxidative stress. Dual-luciferase assays verified miR-93-5p/TNFRSF21 targeting. Functional rescue assays defined TNFRSF21's role in miR-93-5p function. Nuclear-cytoplasmic fractionation determined TNFRSF's subcellular localization, with NF-κB expression assessed to identify downstream pathways.

Results: RT-qPCR combined with ROC curve evaluation identified miR-93-5p as a potential diagnostic marker for BPD, with significant downregulation in affected individuals. Its expression inversely correlated with BPD severity and positively with neonatal Apgar scores. The expression of miR-93-5p is negatively correlated with the risk of developing BPD. In vitro, cellular assays demonstrated that miR-93-5p attenuated hyperoxia-induced cellular injury via promoting proliferation, inhibiting apoptosis, modulating inflammatory mediators, and reducing oxidative stress. In addition, miR-93-5p targets and negatively regulates the positive feedback NF-κB pathway of TNFRSF21 in the cytoplasm, thereby weakening its response to high oxygen damage.

Conclusion: miR-93-5p is involved in BPD development and it serves as an important risk factor for predicting and diagnosing BPD severity. The miR-93-5p/TNFRSF21 regulatory mechanism impacts BPD-related factors, providing new perspectives for clinical BPD treatment.

Background: Neurological involvement in Kawasaki disease (KD) is rare and ranges from mild to severe, occasionally leading to fatal outcomes and poor prognosis. However, its impact on clinical outcomes, particularly coronary artery involvement, remains unclear. This study aimed to investigate neurological manifestations during the acute phase of KD and evaluate their clinical implications, focusing on treatment resistance and coronary complications.

Methods: We analyzed data from the Health Insurance Review and Assessment Service of the Republic of Korea between 2007 and 2022 for patients under 18 years of age diagnosed with KD (ICD-10 code M30.3). Neurological manifestations, ranging from mild and nonspecific symptoms to severe complications, were evaluated.

Results: Among 95,648 patients with KD, neurological manifestations occurred in 4319 (4.51 %), comprising 4540 events. The most common symptoms were febrile seizures (2.40 %), followed by meningitis/aseptic meningitis, headache, seizures, epilepsy, meningoencephalitis, irritability, brain hemorrhage, facial nerve palsy, and cerebral infarction or stroke. There were no significant differences in age or sex distribution between those with and without neurological manifestations, although prevalence was highest in patients >5 years. Neurological manifestations were more frequent in summer and were associated with longer hospital stays (p < 0.001), more frequent use of multiple intravenous immunoglobulin (IVIG) treatments (p < 0.001), and higher transfer and mortality rates (p < 0.001). However, no significant differences were observed in coronary interventions or adjunctive therapy use (aspirin, warfarin, steroids, and infliximab).

Conclusions: Neurological manifestations in KD were associated with more frequent IVIG resistance, but showed no significant association with coronary outcomes.

Background: Beginning in April 2022, a rapid surge in the Omicron variant of severe acute respiratory syndrome coronavirus 2 occurred throughout Taiwan. During this period, infected children might present with neurological complications of varying severity. We aimed to investigate the neurological complications in pediatric patients with coronavirus disease 2019 (COVID-19).

Methods: This single-center study analyzed the clinical and laboratory data of pediatric patients with COVID-19 who were admitted to a tertiary hospital in Taiwan between May 2022 and October 2023. COVID-19 was diagnosed via rapid antigen and real-time polymerase chain reaction testing.

Results: In total, 160 patients with COVID-19 were enrolled (women: 45.6 %, n = 73; average age, 4.10 ± 4.07 years). Among them, 21.3 % (n = 34) had neurological findings and 78.8 % (n = 126) did not. The most common neurological symptoms were altered awareness (28/34, 82.4 %) and seizures (26/34, 76.5 %), and 12 patients (35.3 %) presented with intracranial hypertension. Neurological manifestations were prevalent in preschool-aged children (1-5 years). Fever was highly prevalent in all patients and was seen in 100 % of those with neurological symptoms. Higher serum procalcitonin levels, absolute neutrophil counts, and lower platelet counts were observed in pediatric patients with COVID-19 and neurological symptoms.

Conclusions: Recognizing the severe neurological manifestations of COVID-19 is essential for optimal patient management. Elevated serum procalcitonin levels may be an early biomarker of neurological complications. Moreover, early identification of status epilepticus and intracranial hypertension during the disease's acute phase facilitates risk stratification for adverse outcomes. Thus, we provide a novel approach for predicting critical pediatric COVID-19 cases.

Aims: To analyze the development of the frontal cortical and subcortical areas in children with a history of prematurity and very low birthweight, and to evaluate its relationship with foetal growth restriction (FGR) and birthweight.

Methods: This cohort study was carried out in two stages: retrospectively, considering very low weight newborns born at our hospital between January 2008 and December 2016; and prospectively, performing a structural brain analysis using magnetic resonance imaging and a cognitive performance study using the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V).

Results: The study population consisted of 48 children with an average age of 110.7 months (95 % CI 102.6-118.8) with a history of prematurity and a birthweight of less than 1500g. Of these children, nine had suffered FGR. FGR is associated with a significantly smaller medial orbitofrontal cortex and a significantly larger anterior cingulate cortex. The surface area of the medial orbitofrontal cortex of both hemispheres is significantly associated with the scores obtained in the WISC-V test for verbal comprehension and visual-spatial index.

Conclusions: FGR and birthweight are both related to structural alterations in the frontal lobe. The surface area of the orbitofrontal cortex is strongly influenced by the weight at birth.

Background: Esophageal atresia (EA) is a rare malformation (∼1 in 2500-3000 live birth) typically involving a blind upper pouch and distal tracheoesophageal fistula (TEF) (≈86 % of cases). Atypical forms (such as duplications, vascular rings, or functional obstructions) lie outside standard classifications and they are very uncommon. These variants can confound diagnosis and require adapted strategies.

Methods: We retrospectively reviewed 43 EA cases (2018-2021) and identified three with atypical anatomic or functional presentations. Clinical, radiologic, and endoscopic findings were analyzed. Each case demanded a bespoke diagnostic and surgical plan.

Results: Case 1: A neonate with EA/TEF had a long esophageal duplication with an internal septum. The septum was divided and the esophagus anastomosed; although the repair was intact, the infant later died from aspiration pneumonia. Case 2: EA repair was complicated by a right aortic arch (≈6 % of EA/TEF patients). We tunneled the distal esophagus behind the arch for a thoracoscopic anastomosis. A mild stricture was dilated, and the infant tolerated full feeds. Case 3: Initial imaging suggested EA, but endoscopy showed a continuous but narrowed esophagus (likely a motility disorder). Tube feeding led to normalization by 1 month, avoiding surgery. Two infants survived with good feeding outcomes.

Conclusion: These cases (≈7 % of our EA cohort) illustrate that atypical EA variants require individualized management. Detailed imaging and endoscopy were critical to identify unusual anatomy. Tailored thoracoscopic techniques (such as septum resection and retro-arch anastomosis) restored continuity in two infants, while recognizing a motility obstruction in the third obviated surgery. Awareness of atypical anatomy is essential to improve outcomes.

The level of evidence: IV.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a severe systemic hyperinflammation with a high early death rate. The present study retrospectively reviewed the potential relationship between routine laboratory tests and early death in pediatric HLH patients.

Methods: Sixty-four pediatric HLH patients with complete routine laboratory test results and patient information data were divided into Group D (patients who died within two months of hospitalization) and Group S (patients who survived for more than two months or were ultimately discharged). Demographic characteristics and routine laboratory data were analyzed using the Wilcoxon test, LASSO regression, and logistic regression.

Results: Most patients in Group D were under the age of two. Univariate analysis showed that low red blood cell (RBC), low haemoglobin (Hb), low albumin (ALB), low fibrinogen (FIB), prolonged partially activated prothrombin time (APTT), and high lactate dehydrogenase (LDH) were associated with early death in pediatric HLH patients. Among these routine laboratory tests, ALB had the highest area under the curve (AUC). LASSO regression and logistic regression showed that ALB correlated with early death in pediatric HLH patients.

Conclusions: Our study highlights the importance of routine laboratory tests, especially ALB levels, in predicting early death in pediatric HLH patients. Under the age of 2, multi-organ or system involvement may increase the risk of early death.