Dupont Hospital

The sex chromosome trisomies (SCT), including XXY, XYY, and XXX, are common chromosomal aneuploidies associated with increased risk for early developmental delays and later neurodevelopmental disorders. Precise data on the timing and variability of early milestones in this population remain limited, so despite rising rates of prenatal SCT diagnosis, clinicians and families lack clear, evidence-based expectations for early motor and language development. This study aims to quantify the spectrum of early developmental milestones in infants with SCT and compare their timing with well-established standards for unaffected children to better contextualize early developmental risk. This analysis used data from the eXtraordinarY Babies Natural History Study, a prospective cohort of prenatally identified infants with SCT followed from infancy through early childhood. Between 2 and 36 months of life, parents reported easily observable gross motor and expressive language milestones, and clinicians validated these findings at regularly scheduled study visits as part of a broader assessment of development and health trajectories. A total of 12 milestones were collected for each participant: 8 gross motor skills and 4 expressive communication milestones. To compare these values with a normative reference group, data were retrieved from the Denver II Scales, the WHO Motor Development Study, and the Primitive Reflex Profile. Analyses assessed the median age of acquisition, variance, and differences across SCT karyotypes, as well as the proportion of children who fell outside CDC milestone expectations. Among 298 infants with SCT (174 with XXY, 50 with XYY, and 74 with XXX), results showed a later median age of acquisition for 9 of the 12 milestones evaluated, including rolling front to back, sitting, cruising, walking, running, cooing, babbling, first words, and 2-word phrases. There was also greater variance in milestone timing for the SCT group compared with the reference population, with extended upper percentiles across most skills indicating a wider range of typical achievement. While these delays were statistically significant, there was considerable overlap between the SCT group and the general pediatric population, and only a minority of infants met the CDC criteria for developmental delay. Differences across SCT karyotypes were small and generally not significant, although children with XXY achieved several skills slightly earlier than those with XYY or XXX. These findings provide an evidence-based schedule for early motor and language milestones in infants with SCT to aid early childhood surveillance and counseling. The later median age of acquisition and greater variability observed across all SCT conditions support the need for periodic developmental assessment beyond guidelines for the general population to identify children requiring additional support earlier. Although many infants with SCT will experience developmental trajectories similar to unaffected peers, this study shows that they remain at higher developmental risk and may benefit from increased monitoring, clearer parent guidance, and earlier referral for intervention when indicated.(Abstracted from Pediatrics (2025) 156 (2): e2024068773. doi: 10.1542/peds.2024-068773.).

Background/Aim: We previously reported that late gadolinium enhancement (LGE) on cardiac MRI (CMR) was as high as 82% in pediatric patients with COVID-19 vaccine-associated myocarditis (C-VAM) despite mild clinical symptoms and normal left ventricular function. As LGE can be a harbinger for future adverse events including arrhythmias, heart failure or sudden cardiac death, we sought to identify predictors for LGE in C-VAM, specifically assessing troponin as a screening marker for C-VAM patients at risk for myocardial scarring who could then be referred for a confirmatory CMR with LGE. Methods: In this longitudinal multicenter retrospective observational study across 38 U.S. member institutions of the Myocarditis After COVID Vaccination (MACiV) study network, 333 patients with C-VAM based on CDC criteria were included from April 2021 to November 2022. Data collected included demographics, laboratory values, clinical and cardiac imaging characteristics and outcomes. Using logistic regression, troponin levels at presentation were assessed as a log transformed continuous variable and categorized into tertiles. Results: The C-VAM patients were predominantly white (67%) adolescent males (91%, 15.7± 2.8 years). There were 216/333 (65%) patients who had both a reported troponin value and had a CMR. On univariate analysis, elevated troponin increased the probability of having LGE (OR=1.29, 95% CI: 1.06, 1.58, p=0.012). Even after controlling for age, race, sex, number of vaccine doses and left ventricular ejection fraction (OR=1.32, 95% CI: 1.06, 1.65, p=0.013). Patients >15 years compared to those ≤15 years of age were 2.94 (95% CI: 1.28, 6.75, p=0.011) times more likely to have LGE at presentation. Patients with troponin levels in the highest tertile compared to lowest tertile were 2.66 times (95% CI: 1.04, 6.83, p=0.042) more likely to have LGE along with a greater involvement > 4 AHA myocardial segments with LGE (p=0.004) Conclusions: Higher troponin values are associated with presence of late gadolinium enhancement on cardiac MRI in patients with COVID-19 vaccine-associated myocarditis. Troponin levels at presentation may facilitate risk stratification and function as a screening tool to identify those C-VAM patients with the greatest likelihood of myocardial scarring, who may benefit from undergoing CMR for tissue characterization.

Pediatric cardiac arrest is a rare but time-critical event that poses significant challenges to health care providers. Initiation of point-of-care ultrasound (POCUS) early in resuscitation can help optimize the location of chest compressions, identify inadequate compressions, evaluate for sonographic pulse, and help direct management. Although several algorithms currently exist to incorporate POCUS into adult cardiac arrest, none, to our knowledge, currently exist for the pediatric population. We propose a novel protocol for POCUS use as an adjunct to existing standard-of-care measures in pediatric cardiac arrest, which we call the Pediatric Ultrasound for Life-Supporting Efforts protocol.

Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States. A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact. Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation. Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use. · Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.. · The AAP statement on probiotic use in preterm infants had a modest impact on current practices.. · There's a need for better product regulation and consensus guidelines to ensure standardized use..