Pediatric Research

IntroductionBronchopulmonary dysplasia (BPD) remains a major complication among extremely low gestational age (ELGA) infants, with long-term respiratory and neurodevelopmental consequences. Despite advances in neonatal care, effective therapies to prevent BPD are lacking. Mesenchymal stromal cells (MSC), particularly those derived from umbilical cord (UC-MSC), offer promise due to their pleiotropic effects. Preclinical and early-phase clinical studies have demonstrated safety and potential effic...

Background and ObjectivesCurrent potassium reference intervals for neonates fail to account for sampling method differences and prematurity-related factors, leading to unnecessary resampling and interventions. We aimed to establish sampling-specific potassium reference intervals for term and preterm neonates using comprehensive electronic health record data. MethodsWe analyzed 195 606 blood gas measurements from 10 290 neonates (2007-2024) at a tertiary neonatal intensive care unit. After ex-cl...

Abnormal respiratory microbiomes are reported in children with artificial airways, yet the timing and persistence of these disruptions have not been defined in infants following new tracheostomy placement. We conducted a prospective longitudinal study to characterize airway microbiome dynamics following new tracheostomy placement during early life, a critical period for microbiome development. Fifteen hospitalized infants <=12 months contributed 84 tracheal aspirate samples collected from day 1 ...

OBJECTIVETo develop a parsimonious, interpretable, and accurate model for predicting discharge for premature infants in the NICU that is suitable for prospective evaluation and integration into clinical workflows. STUDY DESIGNUsing routinely available electronic health record data, we developed and validated NEOnatal Reliable Estimation of Approaching Discharge in Young infants (NEO-READY), a daily-updating model that predicts likelihood of discharge within 5 days for premature infants. RESULT...

BackgroundNeonatal jaundice management increasingly relies on transcutaneous bilirubinometry (TcB), yet discrepancies with serum bilirubin (TSB) have limited its clinical reliability. This study introduces Skin Residual Bilirubin Volume (SRBV) as a physiologically grounded framework to enhance TcB interpretation. ObjectiveTo evaluate SRBV as an explanation for TcB-TSB discordance and assess whether incorporating SRBV improves the interpretability and reliability of TcB measurements during diagn...

ObjectivesVentilator-associated pneumonia (VAP) is a significant complication in pediatric patients with severe bronchiolitis undergoing mechanical ventilation (MV) in pediatric intensive care units (PICUs). The role of respiratory microbiota in VAP development remains underexplored in this vulnerable population. This study aimed to characterize respiratory microbiota in critically ill children with severe bronchiolitis receiving critical care and identify microbial patterns associated with VAP....

BackgroundAnti-seizure medications (ASMs) are widely used in neonatal intensive care, but there is limited evidence for their safety and long-term outcomes. Phenobarbital is the only ASM generally recommended for use in neonates, but it has been linked with adverse effects in infants. Other anti-seizure medications, such as fosphenytoin, levetiracetam, and midazolam are used off-label in this population. MethodsWe performed a retrospective observational study of 18,548 infants in intensive care...

Premature birth occurs during a phase of intense brain maturation, making white matter (WM) particularly vulnerable to injury. Beyond major lesions, subtle and widespread microstructural alterations also contribute to later neurodevelopmental impairments. We aimed to characterize the impact of key clinical risk factors on global and tract-specific WM microstructure at term-equivalent age (TEA), using 3T-diffusion-MRI data of 111 infants born before 33 weeks of gestation. We developed a lesion-ro...

Fortification of human milk (HM) is essential to meet the nutritional needs of very low birthweight infants (VLBWI). Most available fortifiers are derived from cows milk, raising concerns about tolerability, immunogenicity and access in low-resource settings. LioNeo is a novel multinutrient fortifier produced exclusively from freeze-dried donor HM by a certified Human Milk Bank in Brazil. Preclinical and Phase 1 testing demonstrated safety and tolerability. This Phase 2 trial evaluated the effic...

BackgroundChildren with tracheostomies experience frequent and recurrent acute respiratory infections (ARIs). While cultured respiratory pathogens can inform ARI diagnosis, it is unknown if their presence in the airway affects future ARI risk. ObjectiveTo identify predictors of frequent (3+) ARIs within 36 months of tracheostomy. MethodsWe conducted a single-center, retrospective cohort study of children with tracheostomies placed between 2010-2016. Medical records were reviewed for each encou...

ImportanceIndividuals exposed to perinatal risk factors are at increased risk for cardiovascular and neurodevelopmental disorders. Heart rate variability, an index of autonomic nervous system function, is widely used to assess long-term health risk in these populations, yet findings remain inconsistent. ObjectiveTo quantify heart rate variability differences between individuals with perinatal risk factors (including preterm birth, intrauterine growth restriction, and low birth weight) and healt...

ImportanceCurrent guidelines from the World Health Organization, Centers for Disease Control and Prevention, and Academy of Breastfeeding Medicine recommend discarding all milk remaining in bottles immediately after infant feeding. However, these recommendations lack supporting microbiological evidence from studies of actual infant feeding, imposing substantial financial and emotional burden on the 78 million families worldwide who bottle-feed their infants. ObjectiveTo determine (1) the financ...

BackgroundTranslocation of bacteria across the intestinal barrier has been postulated to contribute to mortality among severely malnourished children. Pancreatic enzymes (PE) and bile acids (BA) have anti-bacterial properties in the small intestine, but severe malnutrition is associated with impaired exocrine pancreatic and hepatobiliary functions. We evaluated whether ancillary treatment with PE and BA improves survival in hospitalized, acutely ill, severely malnourished children. Methods and ...

Pediatric asthma exacerbations are a frequent cause of emergency department (ED) visits and hospitalizations, yet accurate risk prediction remains limited and no consensus risk scores exist. Using UF Health electronic health records (EHRs) from 2011-2023, we evaluated two computable phenotypes (i.e., CAPriCORN and COMPAC) to predict exacerbations over 6-, 12-, and 24-month horizons. Exacerbations were defined using a validated composite of diagnosis codes from ED, inpatient, or outpatient encoun...

IntroductionPediatric acute appendicitis (PAA) remains challenging to diagnose despite existing diagnostic scores. The BIDIAP index is a three-item diagnostic tool with very high discriminative performance in a derivation cohort. This study aimed to prospectively and externally validate the BIDIAP index in a multicenter pediatric population. Material and MethodsWe conducted a prospective, multicenter observational study across four tertiary pediatric centers, enrolling children presenting with ...

BackgroundThe influence of genetic and environmental factors, especially during early development, is critical in the pathogenesis of autism. Maternal autoantibodies that recognize specific fetal brain proteins can be strong predictors of autism risk. These antibodies cross the placenta and bind to their target antigens, which play critical roles in neurodevelopment, thereby increasing autism risk. This etiologically defined subtype is now referred to as Maternal Autoantibody-Related Autism (MAR...

BackgroundImproved survival in children with congenital heart disease (CHD) has unveiled associated long-term neurocognitive impairments. However, the long-term effects on academic performance and the influence of sex, family, socioeconomic factors, and surgical era remain understudied, limited by small and incomplete cohorts. MethodsThis total-population cohort study, with nested sibling analysis, included 1 800 477 singletons born in Sweden between January 1, 1987, and December 31, 2005. Acad...

BackgroundVolumetric assessment of the fetus, placenta and amniotic fluid is clinically valuable, but MRI volumetry is rarely performed in clinical practice because of the required labour-intensive manual segmentation of motion-corrupted 2-dimensional (2-D) stacks. Existing deep-learning approaches typically segment single structures in 2-D motion-corrupted stacks, are, however limited in accuracy by slice misalignment. No current method provides a reliable automated solution for whole-uterus vo...

IntroductionCentral line-associated bloodstream-infection (CLA-BSI) and catheter-related bloodstream infections (CR-BSI) remain a significant concern in pediatric inpatient units. ObjectiveTo analyze a case series of CLA-BSI and CR-BSI in hospitalized pediatric patients in hospitals with rigorous infection prevention measures. Materials and MethodsThis was an analytical, descriptive, and retrospective study conducted in patients aged 0 to 18 years, admitted between August 2023 and March 2025, ...

Typically-developing children progress through three distinct language-comprehension phenotypes. 1) The Command Phenotype, emerging by age 2, is characterized by understanding single words and simple commands. 2) The Modifier Phenotype, observed around age 3, is characterized by understanding adjective-noun combinations. 3) The Syntactic Phenotype, reached by age 4, is characterized by understanding stories and complex syntactic structures. This study examined language-comprehension trajectories...