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Editor’s Focus

Early Career Investigator

Congratulations to Rawad Obeid, the Early Career Investigator for June 2021. He is a pediatric and neonatal neurologist and the director of the Neonatal Neurology program at Beaumont’s Children’s Hospital in Detroit, Michigan. Dr. Obeid grew up in Damascus, Syria, where, influenced by his father, a caring and astute pediatrician, he entered medicine. Following graduation, he did his residency at Children’s Hospital of Michigan, where he was further influenced by Seetha Shankaran and Harry Chugani. He received his pediatric neurology training at the Children’s Hospital of Pittsburgh, mentored by Michael Painter. Dr. Obeid was accepted as the first research fellow in neonatal neurology at Children’s National Medical Center In Washington, DC, under the mentorship of Anna Penn and Taeun Chang, and received a Thrasher Early Career funding award. In this issue of Pediatric Research, he and colleagues report that the fronto-temporal horn ratio can be used as a marker of ventriculomegaly in premature newborns and, potentially, to direct treatment for post-hemorrhagic ventricular dilatation. In an accompanying Comment, Cizmeci and de Vries point out the novelty and interest of that article. Dr. Obeid believes in the importance of mentorship and guidance, as well as in patience and motivation: “The final product is always worth it.” See https://doi.org/10.1038/s41390-021-01481-y, https://doi.org/10.1038/s41390-020-01337-x and https://doi.org/10.1038/s41390-021-01379-9

Gene signature of children with severe RSV infection

There are still limited therapeutic options for children with severe respiratory syncytial virus (RSV) infections. Gaining insight into host cellular response during infection might provide starting points for new therapies. Dapat et al. tested RNA in blood samples from hospitalized children with mild and severe RSV infection. They observed changes in the expression patterns of both innate and adaptive immune responses that appeared to be related to disease severity. Candidate drugs were identified that potentially will target the cellular processes influenced by these altered gene expressions. In a related Comment, In a related Pediatric Policy Committee commentary, Balasubramaniam et al. make a plea for transdisciplinary collaboration in order to improve the health of tomorrow’s children, a process that will require a paradigm shift by all parties involved. See https://doi.org/10.1038/s41390-020-01347-9 and https://doi.org/10.1038/s41390-021-01482-x

Transcriptome profiles of children with metabolic healthy vs. unhealthy overweight/obesity

In addition to the COVID-19 pandemic, a worldwide pandemic in childhood overweight/obesity is occurring. Plaza-Florido et al. identified differences in gene expression using whole-blood transcriptome profiling between children with metabolic healthy overweight or obesity (MHO) and those with metabolic unhealthy overweight/obesity (MUO). Thirty-two of 40 differentially expressed genes are linked to pathways in metabolic, mitochondrial, or immune function. Children with MHO showed a favorable inflammatory profile and higher expression of genes involved in fatty acid synthesis and cholesterol metabolism compared with children with MUO. This finding may provide further insight into the underlying mechanisms by which a subset of the population remains healthy despite overweight/obesity. In the related Editorial, Widhalm provides background on the hypotheses related to the etiology of obesity. See https://doi.org/10.1038/s41390-020-01276-7 and https://doi.org/10.1038/s41390-021-01378-w

Vertical transmission of SARS-CoV-2 from mother to baby

In the current era of the COVID-19 pandemic, information about vertical transmission is scarce. Rebello et al. describe their investigation of a premature infant born to a mother diagnosed with COVID-19 a week before delivery. Samples collected from the umbilical cord blood and two skin swabs taken immediately after birth and tested for SARS-CoV-2 with real-time PCR tested positive for the virus. The results of consecutive oropharyngeal swabs were negative, as were IgM and IgG tests after birth. Using real-time PCR to document vertical transmission of SARS-CoV-2 makes it possible to study potential perinatal consequences (Photo: Cavan Images/Getty). See https://doi.org/10.1038/s41390-020-01193-9

Pain and the fetus/neonate

This issue contains several articles addressing aspects of pain, reflecting the increasing interest in this issue. Topics range from the use of methadone to varied pain scales. Van den Hoogen et al. show in a rat model that methadone effectively blocks the pain associated with repetitive painful procedures. This article prompted a Comment by van den Anker, in which he examines the possibility of replacing morphine with methadone in the neonatal intensive care unit. The review by Bellieni discusses the necessity of providing direct fetal analgesia during fetal surgery and presents safety guidelines for doing so. Xie et al. assessed four pain scales in 111 preterm infants. Gendras et al. describe simultaneous measurements of pain responses using the Newborn Infant Parasympathetic Evaluation (NIPE) index, skin conductance responses, and the Premature Infant Pain Profile–Revised (PIPP-R) in 254 procedures in 90 preterm infants. Together, these articles offer a wealth of new information on this important topic. See https://doi.org/10.1038/s41390-020-01353-x, https://doi.org/10.1038/s41390-021-01472-z, https://doi.org/10.1038/s41390-020-01170-2, https://doi.org/10.1038/s41390-020-1034-z, and https://doi.org/10.1038/s41390-020-01152-4

Influence of race/ethnicity and income on adverse childhood experiences

Early adverse experiences, such as abuse or neglect, may influence the course of a child’s life. The cumulative effect of such adverse childhood experiences (ACEs) has an impact on overall well-being. Goldstein et al. analyzed health data reported by parents for more than 40,000 children aged 6–17 years. More than half of the children live below poverty level, and 45% experienced at least one ACE. Black males living below poverty level had the highest proportion (38%) of those with two or more ACEs. The authors observed that family resilience reduced the negative impact of ACEs on flourishing. The effect on flourishing varied by race/ethnicity and family poverty level. The findings indicate that racial/ethnic minorities and families living below poverty levels are more vulnerable to ACE exposure and impact. We—as a society and as pediatric researchers—should do our utmost to prevent ACEs by contributing to public policies, health care, and research on this topic. See https://doi.org/10.1038/s41390-020-01188-6

Sex-typical behavior in VLBW children

Lamminmäki et al. assessed sex-typical behavior in 879 children at a mean age of 5 years. This cohort of children consisted of preterm children with very low birthweight (VLBW; <1500 g), preterm children with birthweight ≥1500 g, and full-term children. More than half had been exposed to antenatal synthetic glucocorticoids (sGCs). The Pre-school Activities Inventory (PSAI) was used to assess the sex-typical behavior of this cohort. The authors found no effect of sGCs on PSAI scores in either sex. There was a slightly, but significantly, lower PSAI score in VLBW infants than in other infants, for both boys and girls. VLBW was associated with less-masculine PSAI scores in boys and less-feminine PSAI scores in girls. See https://doi.org/10.1038/s41390-020-01133-7

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Editor’s Focus. Pediatr Res 89, 1583 (2021). https://doi.org/10.1038/s41390-021-01597-1

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