Ronan Victoria
Department of Pediatrics, Section of Critical Care, Children's Wisconsin/Medical College of Wisconsin, Milwaukee, WI, United States.
Front Pediatr. 2025 Jan 20;12:1499330. doi: 10.3389/fped.2024.1499330. eCollection 2024.
Among patients admitted to the pediatric intensive care unit, approximately 10% are discharged with a new functional morbidity. For those who were admitted with a neurocritical illness, the number can be as high as 60%. The most common diagnoses for a neurocritical illness admission include traumatic brain injury, status epilepticus, post-cardiac arrest, hypoxic ischemic encephalopathy, meningo/encephalitis, and stroke. The gut-brain axis is crucial to childhood development, particularly neurodevelopment. Alterations on either side of the bidirectional communication of the gut-brain axis have been shown to alter typical development and have been associated with autism spectrum disorder, anxiety, sleep disturbances, and learning disabilities, among others. For those patients who have experienced a direct neurologic insult, subsequent interventions may contribute to dysbiosis, which could compound injury to the brain. Increasing data suggests the existence of a critical window for both gut microbiome plasticity and neurodevelopment in which interventions could help or could harm and warrant further investigation.
在入住儿科重症监护病房的患者中，约10%出院时出现新的功能障碍。对于因神经危重症入院的患者，这一比例可能高达60%。神经危重症入院最常见的诊断包括创伤性脑损伤、癫痫持续状态、心脏骤停后、缺氧缺血性脑病、脑膜/脑炎和中风。肠脑轴对儿童发育，尤其是神经发育至关重要。肠脑轴双向交流的任何一侧发生改变都已被证明会改变正常发育，并与自闭症谱系障碍、焦虑、睡眠障碍和学习障碍等有关。对于那些经历过直接神经损伤的患者，后续干预可能会导致肠道菌群失调，进而加重脑损伤。越来越多的数据表明，肠道微生物群可塑性和神经发育存在一个关键窗口期，在此期间进行干预可能有益也可能有害，值得进一步研究。
