JAMA Pediatrics最新文献

{"title":"Low-Intensity Social Care and Child Acute Health Care Utilization","authors":"Stacy Tessler Lindau, Jennifer A. Makelarski, Victoria A. Winslow, Emily M. Abramsohn, Veera Anand, Deborah L. Burnet, Charles M. Fuller, Mellissa Grana, Doriane C. Miller, Eva S. Ren, Elaine Waxman, Kristen E. Wroblewski","doi":"10.1001/jamapediatrics.2025.0484","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0484","url":null,"abstract":"ImportanceSocial care could be sustained with savings resulting from reduced acute health care utilization.ObjectiveTo evaluate the impact of CommunityRx, a low-intensity, high-scale social care assistance intervention.Design, Setting, and ParticipantsThis double-blind randomized clinical trial took place from November 2020 through August 2023 at an urban children’s hospital with 12-month follow-up. Inclusion criteria were primary caregiver of a child younger than 18 years who was hospitalized in general, intensive care, or transplant units, living in 1 of 42 zip codes, and consenting to text messages. Caregivers of healthy newborns and children with expected hospitalization less than 24 hours or longer than 30 days were excluded.InterventionsParticipants were randomized to usual care (n = 320) or usual care plus CommunityRx (n = 320). Essential intervention components included education about common social conditions, personalized information about local resources, and ongoing navigator support with automated, proactive text messages (3 months) and ongoing availability for participant-initiated requests (12 months).Main Outcomes and MeasuresPreplanned analyses focused on food insecure (FI) subgroup outcomes (n = 223): self-efficacy for finding resources at 12 months (primary), caregiver-reported child health, and number of child emergency department (ED) and hospital admissions over 12 months. Regression models were fit with treatment group and baseline outcome characteristics. Odds ratios (ORs) or incidence rate ratios (IRRs) and 95% CIs were calculated. Post hoc analysis examined outcomes among the food secure (FS) subgroup (n = 414).ResultsPreplanned analyses included 223 FI participants and most identified as female (180 [95%]) and had household income less than $50 000 per year (197 [91%]). Self-efficacy at 12 months was similar among treatment groups (OR, 0.59; 95% CI, 0.25-1.39, <jats:italic>P</jats:italic> = .23). At 3 months, when automated navigator texts ended, 53 intervention group participants (69%) and 39 controls (45%) rated their child’s health as excellent or very good (OR, 2.67; 95% CI, 1.14-6.24). During 12 months postdischarge, 54 FI children (41%) had 1 or more ED visits (median, 0; range, 0-32; intervention, 30%; control, 52%; IRR, 0.40; 95% CI, 0.21-0.76) and 32 had 1 or more hospitalizations (24%) (median, 0; range, 0-5; intervention, 15%; control, 34%; IRR, 0.48; 95% CI, 0.21-1.06). The intervention did not impact outcomes among FS caregivers.Conclusions and RelevanceA low-intensity, high-scale social care assistance intervention beginning with pediatric hospitalization may be sustainable by reducing acute health care utilization, but did not increase caregiver self-efficacy for finding resources.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT04171999?term=NCT04171999&rank=1\">NCT0417","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"96 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Maternal, Fetal, and Infant Mortality in the US, 2000-2023","authors":"Robin Y. Park, Alyssa Bilinski, Robbie M. Parks, Seth Flaxman","doi":"10.1001/jamapediatrics.2025.0440","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0440","url":null,"abstract":"ImportanceAccurately measuring maternal mortality trends has been challenging due to changes in data collection. This work disambiguates trends from the effects of introducing the pregnancy checkbox on death certificates and also analyzes closely related fetal and infant mortality.ObjectiveTo describe trends in maternal, fetal, and infant deaths since 2000, including the impact of the COVID-19 pandemic.Design, Setting, and ParticipantsA national, population-level, epidemiological, cross-sectional analysis during 2000 to 2023 was conducted as well as a staggered difference-in-differences analysis on the pregnancy checkbox, using the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying causes of death in the US to identify maternal, infant, and fetal deaths. Study population was restricted to mothers aged 15 to 44 years for all definitions of maternal mortality.ExposuresStaggered introduction of the pregnancy checkbox on death certificates across different states.Main Outcomes and MeasuresLongitudinal study (2000-2023) reporting crude rates per 100 000 population for adjusted maternal mortality and per 1000 population for fetal and infant mortality at the national level and by US Census Bureau–designated main census regions, age groups, and race and ethnicity. Staggered difference-in-differences counterfactuals (1999-2023) on impact of pregnancy checkbox.ResultsThe introduction of the pregnancy checkbox was associated with 6.78 (95% CI, 1.47-12.09) deaths per 100 000 live births increase in reported maternal mortality, 66% (95% CI, 14%-117%) of the total increase from 2000 to 2019, with a smaller impact on maternal mortality excluding cause unspecified (adjusted maternal death rates). Adjusted maternal death rates remained consistently between 6.75 (95% CI, 5.97-7.61) to 10.24 (95% CI, 9.22-11.34) per 100 000 live births from 2000 until 2021, when it peaked at 18.86 (95% CI, 17.48-20.32); the rate dropped to 10.23 (95% CI, 9.22-11.32) in 2022. The death rates of Native American or Alaska Native women increased the most during the COVID-19 period, almost tripling from 2011 to 2019 (10.70 per 100 000 live births; 95% CI, 7.64-14.57) to the 2020 to 2022 period (27.47 per 100 000 live births; 95% CI, 18.39-39.45). The death rates of non-Hispanic Black women were highest across time—approximately triple the rate of non-Hispanic White women in each time period. Infant death rates per 1000 live births dropped from 6.93 (95% CI, 6.85-7.01) in 2000 to 5.44 (95% CI, 5.36-5.51) in 2020, increasing slightly to 2018 levels in 2021 to 2023. Fetal death rates per 1000 live births decreased from 6.28 (95% CI, 6.16-6.31) in 2005 to 5.53 (95% CI, 5.45-5.60) in 2022.Conclusion and RelevanceUsing difference-in-differences analyses, results of this study reveal that the pregnancy checkbox explained much of the observed increase in maternal mortality before the COVID-19 pandemic. Nevertheless, ","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"11 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Parents Need to Know About Online Misinformation","authors":"Nusheen Ameenuddin, Lindsay A. Thompson","doi":"10.1001/jamapediatrics.2025.0290","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0290","url":null,"abstract":"This <jats:italic>JAMA Pediatrics</jats:italic> Patient Page describes how parents can help their children build media literacy skills to recognize online misinformation.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"82 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends in the Childhood Opportunity Index at Children’s Hospitals","authors":"Samantha A. House, Matthew Hall, Clemens Noelke, Yang Lu, Victor Ritter, Bren Botzheim, Alicia Lew, Alan R. Schroeder","doi":"10.1001/jamapediatrics.2025.1041","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.1041","url":null,"abstract":"This cohort study assessed annual changes in the Childhood Opportunity Index, a multidimensional measure of neighborhood conditions associated with health outcomes, for hospital-based encounters.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"130 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type I Error Control-Avoiding an Upset.","authors":"John M VanBuren,Benjamin French","doi":"10.1001/jamapediatrics.2025.0528","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0528","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"6 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-Level Policies and Antibiotic Use for Pediatric Conjunctivitis","authors":"Isdin Oke, Alexandra T. Geanacopoulos, S.V. Subramanian, Ann Chen Wu, Naomi S. Bardach, Daniel J. Shapiro","doi":"10.1001/jamapediatrics.2025.0478","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0478","url":null,"abstract":"This cross-sectional study examines the patterns of topical antibiotics dispensation to commercially insured school-aged children with acute infectious conjunctivitis.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"28 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Intraventricular Hemorrhage in Preterm Neonates During the First 6 Hours of Life-Reply.","authors":"Zsuzsanna Nagy,Tamás Kói,Miklós Szabó","doi":"10.1001/jamapediatrics.2025.0472","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0472","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"138 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Intraventricular Hemorrhage in Preterm Neonates During the First 6 Hours of Life.","authors":"Sameer Yaseen Al-Abdi,Maryam Ali Al-Aamri","doi":"10.1001/jamapediatrics.2025.0475","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0475","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"16 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Mental and Physical Health Among Youths.","authors":"Marie E Heffernan,Michelle L Macy","doi":"10.1001/jamapediatrics.2025.0556","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0556","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"91 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium","authors":"Kiyoyuki W. Miyasaka, Yasuyuki Suzuki, Emery N. Brown, Yasuko Nagasaka","doi":"10.1001/jamapediatrics.2025.0517","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0517","url":null,"abstract":"ImportancePediatric anesthesia emergence delirium (PAED) is a common complication of general anesthesia and has unknown etiology. Exposure to volatile anesthetics may contribute to PAED, and excessive exposure may occur frequently during routine pediatric anesthesia.ObjectiveTo examine whether use of electroencephalography (EEG) monitoring can reduce PAED by minimizing exposure to sevoflurane while maintaining a state of unconsciousness under anesthesia.Design, Setting, and ParticipantsA single-center, parallel-group, 2-arm, superiority randomized clinical trial with a 1:1 allocation ratio was conducted from October 13, 2021, to March 18, 2023, at an academic tertiary pediatric hospital in Japan. The follow-up period was 24 ± 6 hours postoperatively or uneventful discharge to home, whichever came first. The observer for the primary outcome was blinded to patient assignment. The trial included a convenience sample of children aged 1 to younger than 6 years undergoing general anesthesia for procedures for which reliable antinociception can be provided. Data analysis was performed in March 2023.InterventionEEG-guided titration of anesthesia to minimize sevoflurane exposure (EEG-guided group) vs standard 1.0–minimum alveolar concentration (MAC) sevoflurane anesthesia (control group).Main Outcomes and MeasuresProportion of patients who developed PAED, defined by a maximum PAED score of 10 or higher.ResultsOf the 177 participants who completed follow-up, 125 (71%) were male and 52 (29%) were female. The EEG-guided group included 91 participants (mean [SD] age, 2.9 [1.5] years), and the control group included 86 participants (mean [SD] age, 2.8 [1.6] years). In the EEG-guided group, sevoflurane exposure was reduced by 1.4 MAC-hours (96.65% CI, 1.1 to 1.6 MAC-hours). A total of 30 (35%) in the control group and 19 (21%) in the EEG-guided group developed PAED (difference, 14%; 96.65% CI, −0.0019% to 28%; 95% CI, 0.92% to 27%; <jats:italic>P</jats:italic> = .04). Children in the EEG-guided group emerged a mean of 21.4 minutes (96.65% CI, 15.4 to 27.4 minutes) earlier from general anesthesia and spent a mean of 16.5 minutes less (96.65% CI, 10.8 to 22.3 minutes less) in the postanesthesia care unit.Conclusions and RelevanceEEG-guided management of general anesthesia reduced sevoflurane exposure and pediatric anesthesia emergence delirium in children, with faster emergence and shorter postanesthesia care unit stays. The findings suggest that high concentrations of sevoflurane for induction followed by routine use of 1.0-MAC sevoflurane for maintenance may be excessive.Trial RegistrationJapan Registry of Clinical Trials Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://jrct.mhlw.go.jp/en-latest-detail/jRCTs032210248\">jRCTs032210248</jats:ext-link>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"24 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}