Editorâ€™S Focus

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EDITOR’S FOCUS Comment, In a related Pediatric Policy Committee article prompted a Comment by van den Anker, in Volume 89 No. 7 May 2021 commentary, Balasubramaniam et al. make a plea for which he examines the possibility of replacing transdisciplinary collaboration in order to improve morphine with methadone in the neonatal intensive the health of tomorrow’s children, a process that will care unit. The review by Bellieni discusses the Early Career Investigator require a paradigm shift by all parties involved. See necessity of providing direct fetal analgesia during pages 1664 and 1604 fetal surgery and presents safety guidelines for doing so. Xie et al. assessed four pain scales in 111 preterm Transcriptome proﬁles of children infants. Gendras et al. describe simultaneous mea- surements of pain responses using the Newborn with metabolic healthy vs. unhealthy Infant Parasympathetic Evaluation (NIPE) index, skin overweight/obesity conductance responses, and the Premature Infant Pain Proﬁle–Revised (PIPP-R) in 254 procedures in 90 KPTN

ADAMTSL2

TESPA1 preterm infants. Together, these articles offer a PRPH2 SLC9A3

MYH7 Congratulations to Rawad Obeid, the Early Career MYO3A PRODH2 wealth of new information on this important topic.

NXN CCL17 KIR2DS1 SPATA5L1 Investigator for June 2021. He is a pediatric AK1 See pages 1681, 1608, 1612, 1724, and 1840 DSC1 FGF8 ST14 C1orf61 FAM83E GPRC5D SEMA7A GFRA3 and neonatal neurologist and the director of CCDC70CCC NRG1 ARHGAP22 ZNF560 TSSK1B TMC5 CISH ’ TOMM20L PRG2 THSD4T RREB1 the Neonatal Neurology program at Beaumont s FBXW4 fl SLC44A1 CCDC180 HCRTR2R2 In uence of race/ethnicity and IRF2BP2 ’ MPRIP DKKL1 GMCL1 Children s Hospital in Detroit, Michigan. Dr. Obeid CMIP POM121C CYP3A5 HIPK1 UPF1 grew up in Damascus, Syria, where, influenced by his FAM53A income on adverse childhood father, a caring and astute pediatrician, he entered ZNF559 COL26A1 MOV10L1 TMEM253 ARL17A experiences medicine. Following graduation, he did his residency In addition to the COVID-19 pandemic, a worldwide ’ CUR at Children s Hospital of Michigan, where he was pandemic in childhood overweight/obesity is occur- further influenced by Seetha Shankaran and Harry ring. Plaza-Florido et al. identified differences in gene FIN Chugani. He received his pediatric neurology train- expression using whole-blood transcriptome profil- ACE ing at the Children’s Hospital of Pittsburgh, men- RES ing between children with metabolic healthy over- RESIL tored by Michael Painter. Dr. Obeid was accepted as weight or obesity (MHO) and those with metabolic the first research fellow in neonatal neurology at ’ unhealthy overweight/obesity (MUO). Thirty-two of Talk Work Strength Hope Children s National Medical Center In Washington, 40 differentially expressed genes are linked to DC, under the mentorship of Anna Penn and Taeun pathways in metabolic, mitochondrial, or immune Early adverse experiences, such as abuse or neglect, Chang, and received a Thrasher Early Career funding function. Children with MHO showed a favorable may influence the course of a child’s life. The

1234567890();,: Pediatric Research award. In this issue of ,heand inflammatory profile and higher expression of genes cumulative effect of such adverse childhood experi- colleagues report that the fronto-temporal horn ratio involved in fatty acid synthesis and cholesterol ences (ACEs) has an impact on overall well-being. can be used as a marker of ventriculomegaly in metabolism compared with children with MUO. This Goldstein et al. analyzed health data reported by premature newborns and, potentially, to direct finding may provide further insight into the under- parents for more than 40,000 children aged 6–17 treatment for post-hemorrhagic ventricular dilata- lying mechanisms by which a subset of the years. More than half of the children live below tion. In an accompanying Comment, Cizmeci and de population remains healthy despite overweight/ poverty level, and 45% experienced at least one ACE. Vries point out the novelty and interest of that obesity. In the related Editorial, Widhalm provides Black males living below poverty level had the article. Dr. Obeid believes in the importance of background on the hypotheses related to the highest proportion (38%) of those with two or more mentorship and guidance, as well as in patience and etiology of obesity. See pages 1687 and 1584 ACEs. The authors observed that family resilience motivation: “The final product is always worth it.” reduced the negative impact of ACEs on flourishing. See pages 1601, 1715, and 1602 Vertical transmission of SARS-CoV-2 The effect on flourishing varied by race/ethnicity and family poverty level. The findings indicate that racial/ Gene signature of children with from mother to baby ethnic minorities and families living below poverty severe RSV infection levelsaremorevulnerabletoACEexposureand impact. We—as a society and as pediatric researchers a —should do our utmost to prevent ACEs by contributing to public policies, health care, and In the current era of the COVID-19 pandemic, research on this topic. See page 1861 information about vertical transmission is scarce. Rebello et al. describe their investigation of a Sex-typical behavior in VLBW premature infant born to a mother diagnosed with children COVID-19 a week before delivery. Samples col-

100

lected from the umbilical cord blood and two skin p = 0.02 80 n.s.

swabs taken immediately after birth and tested for 60 Boys Girls

PSAI p = 0.02 Upregulated 40 n.s. Downregulated SARS-CoV-2 with real-time PCR tested positive for Interacting partners 20 b Neutrophil Inflammation the virus. The results of consecutive oropharyngeal 0 PT <1500 g PT 1500 g FT TAS2R40 TLR5 LPAR2 TLR8 swabs were negative, as were IgM and IgG tests HCAR2 lRAK4 CCR1 C5AR1 ANXA1 GNB2 P2RY13 TLR2 after birth. Using real-time PCR to document Lamminmäki et al. assessed sex-typical behavior GNG5 CXCL16 CXCR2 GNG10 TLR4 CXCR1 CXCR4 GNAl3 vertical transmission of SARS-CoV-2 makes it in 879 children at a mean age of 5 years. This FPR1 LRMP PPP2R5A LYN LAMP2 CD63 BTK LCK possible to study potential perinatal consequences cohort of children consisted of preterm children DAPP1 RAB3D ARL8A BRl3 PLCG2 VAPA PLCG1 lTK (Photo: Cavan Images/Getty). See page 1592 GLlPR1 with very low birthweight (VLBW; <1500 g), ATP11B NFAM1 HCK FGR ZAP70 preterm children with birthweight ≥1500 g, and Upregulated Downregulated T cell Pain and the fetus/neonate full-term children. More than half had been There are still limited therapeutic options for children exposed to antenatal synthetic glucocorticoids 2.5 TC

NP with severe respiratory syncytial virus (RSV) infec- 2.0 (sGCs). The Pre-school Activities Inventory (PSAI) NP+M tions. Gaining insight into host cellular response 1.5 wasusedtoassessthesex-typicalbehaviorofthis 1.0 50% PWT (g) during infection might provide starting points for 0.5 cohort. The authors found no effect of sGCs on 0.0 P0_1 P0_3 P0_5 P1_1 P1_3 P1_5 P2_1 P2_3 P2_5 P3_1 P3_3 P3_5 P4_1 P4_3 P4_5 P5_1 P5_3 P5_5 P6_1 P6_3 P6_5 P7_1 P7_3 P7_5

new therapies. Dapat et al. tested RNA in blood P0_BS P1_BS P2_BS P3_BS P4_BS P5_BS P6_BS P7_BS PSAI scores in either sex. There was a slightly, but fi samples from hospitalized children with mild and This issue contains several articles addressing aspects signi cantly, lower PSAI score in VLBW infants severe RSV infection. They observed changes in the of pain, reflecting the increasing interest in this issue. than in other infants, for both boys and girls. expression patterns of both innate and adaptive Topics range from the use of methadone to varied VLBW was associated with less-masculine PSAI immune responses that appeared to be related to pain scales. Van den Hoogen et al. show in a rat scores in boys and less-feminine PSAI scores in disease severity. Candidate drugs were identified that girls. Seepage1765 fl model that methadone effectively blocks the pain potentially will target the cellular processes in u- associated with repetitive painful procedures. This enced by these altered gene expressions. In a related