JAMA Pediatrics最新文献

{"title":"Clinicians Have Crucial Roles in Diagnosis in an AI World","authors":"Ellen Wright Clayton","doi":"10.1001/jamapediatrics.2025.2200","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2200","url":null,"abstract":"This Viewpoint describes how clinicians can use artificial intelligence (AI) as a tool for support to give them the opportunity to focus on the interpersonal aspects of patient care.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"61 30 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715293","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":"Optimal Dose of Intranasal Midazolam for Procedural Sedation in Children","authors":"Daniel S. Tsze, Hilary A. Woodward, Son H. McLaren, Cheng-Shiun S. Leu, April M. R. Venn, Nina Y. Hu, Pamela L. Flores-Sanchez, Bianca R. Stefan, Sripriya T. Shen, Mina J. Ekladios, Joseph P. Cravero, Peter S. Dayan","doi":"10.1001/jamapediatrics.2025.2181","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2181","url":null,"abstract":"ImportanceIntranasal (IN) midazolam is commonly used for procedural sedation in children, but the optimal dose is unclear. Insufficient dosing may result in inadequate sedation, leading to short- and long-term consequences associated with poorly managed procedural pain and distress, whereas doses that are too high may be associated with more adverse events.ObjectiveTo determine the optimal dose of IN midazolam for procedural sedation in children undergoing laceration repair.Design, Setting, and ParticipantsThis prospective, double-blind, adaptive selection randomized clinical trial used the Levin-Robbins-Leu sequential selection procedure and was conducted between September 2021 and May 2024 at a tertiary care pediatric emergency department. Participants were children aged 6 months to 7 years with a simple laceration who required IN midazolam to facilitate the repair. The sequential selection procedure eliminated doses when they failed to achieve a prespecified rate of adequate sedation state compared with the best-performing dose. If more than 1 dose survived elimination, secondary outcomes of remaining doses were compared. Data were analyzed from June to August 2024.InterventionsDoses of 0.2, 0.3, 0.4 or 0.5 mg/kg of IN midazolam.Main Outcomes and MeasuresThe primary outcome was adequate sedation state, defined as Pediatric Sedation State Scale (PSSS) score of 2, 3, or 4 (of 5) for at least 95% of the procedure; no PSSS score of 0 or 1; procedure start within 17 minutes of IN midazolam administration; and procedure completion. Secondary outcomes included ideal sedation state (PSSS score of 2 or 3 for 100% of the procedure), time to onset of minimal sedation, adverse events, time to recovery, and clinician and caregiver satisfaction.ResultsFollowing the sequential selection procedure, a total of 101 children (38 [37.6%] female; median [IQR] age, 3 [2-4] years) were enrolled. The 0.2 and 0.3 mg/kg doses were eliminated, with 19 children receiving 0.2 mg/kg and 24 children receiving 0.3 mg/kg. The 0.4- and 0.5-mg/kg doses remained at enrollment completion, with 29 children receiving 0.4 mg/kg and 29 children receiving 0.5 mg/kg. There were no differences in secondary outcomes between the 2 remaining doses and no serious adverse events with any dose.Conclusions and RelevanceIn this randomized clinical trial, the optimal doses of IN midazolam for procedural sedation in children undergoing laceration repair were 0.4 and 0.5 mg/kg. This finding can inform clinical practice and future studies of IN midazolam for procedural sedation.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/NCT04586504\">NCT04586504</jats:ext-link>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"97 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715329","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":"Global Prevalence of Hypertension in Children and Adolescents Younger Than 19 Years","authors":"Xiaorui Ruan, Anji Zhu, Tingting Wang, Mengting Sun, Kebin Chen, Manjun Luo, Zhanwen Li, Qi Zou, Ye Chen, Yuan Peng, Jiabi Qin","doi":"10.1001/jamapediatrics.2025.2206","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2206","url":null,"abstract":"ImportancePediatric hypertension predicts adult hypertension and early target organ damage, yet global prevalence estimates based on different diagnostic principles remain scarce.ObjectiveTo estimate global pediatric hypertension prevalence according to different diagnostic principles.Data SourcesSeveral databases, including PubMed, Web of Science, Embase, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database, were systematically searched from inception to July 7, 2024.Study SelectionStudies were included if they were original investigations in children and adolescents younger than 19 years, represented the general population, and provided data on hypertension prevalence.Data Extraction and SynthesisData screening and extraction were performed independently by 2 authors. A random-effects model was used to estimate prevalence. Temporal trends, as well as regional and population differences, were explored. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and the Egger test.Main Outcomes and MeasuresThe primary outcome was pediatric hypertension, categorized into sustained hypertension (persistent diagnosis confirmed on ≥3 separate occasions) and occasional hypertension (initial diagnosis determined by blood pressure measurements on a single screening visit).ResultsA total of 271 studies involving 16 328 individuals with sustained hypertension, 538 735 individuals with occasional hypertension, and 3 609 665 children and adolescents were included for analysis. The global prevalence of pediatric hypertension was 3.89% (95% CI, 3.27%-4.62%) for sustained hypertension and 11.85% (95% CI, 10.98%-12.75%) for occasional hypertension. Increasing trends with time were observed, with an annual increase of 7.20% (95% CI, 4.16%-10.32%; <jats:italic>P</jats:italic> &amp;amp;lt; .001) from 2006 to 2021 for sustained hypertension and an estimated annual percentage change of 0.33% (95% CI, 0.10%-0.56%) between 1987 and 2022 for occasional hypertension. Additionally, significant differences were observed across geographical regions and population characteristics for the prevalence of pediatric hypertension. Children and adolescents with obesity or overweight (16.35% and 6.79% vs 2.57% [normal weight] for sustained hypertension) had significantly higher prevalence of hypertension.Conclusions and RelevanceThis systematic review and meta-analysis indicates substantial variations in the global prevalence of sustained and occasional hypertension, highlighting the importance of measurements on multiple occasions to enhance reliability. Notable differences in prevalence across individuals’ body mass index values highlight the necessity for targeted interventions to promote healthy lifestyles.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"20 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715328","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 Over Time in Cognitive Outcomes of Children Born Very Preterm","authors":"Soodabeh Behboodi, Anna Chaimani, Valerie Benhammou, E. Sabrina Twilhaar, Samantha Johnson, Jennifer Zeitlin, Mariane Sentenac","doi":"10.1001/jamapediatrics.2025.2221","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2221","url":null,"abstract":"ImportanceProgress in perinatal care has improved survival for children born very preterm (VPT), but these children remain at higher risk of cognitive impairment compared with children born at term.ObjectiveTo synthesize cohort studies on childhood cognitive ability following VPT birth to investigate trends over time.Data SourcesAll studies from 5 previous meta-analyses of VPT birth and cognition published before 2019 were included, and PubMed, Web of Science, and PsycInfo were searched for new studies published up to June 2024.Study SelectionStudies reporting IQ scores of children (aged &amp;amp;lt;18 years) born VPT (&amp;amp;lt;32 weeks’ gestational age [GA] or birth weight &amp;amp;lt;1500 g) with a term-born comparison group were included.Data Extraction and SynthesisTwo reviewers independently selected studies, extracted data, and evaluated study quality using a modified version of the Newcastle-Ottawa Scale. Unique cohorts were identified to avoid duplicate measures from studies on the same children.Main Outcomes and MeasuresThe standardized mean difference (SMD) of IQ scores between VPT-born and term-born children was calculated, and mixed-effects metaregression was used to investigate linear and nonlinear associations between median birth year and the SMD. The main analysis focused on cohorts with IQ measured between 4 and 7 years of age to allow comparison at similar assessment ages. Secondary analyses were conducted in all cohorts using IQ obtained at the latest assessment age.ResultsA total of 257 studies reported data from 131 cohorts of 25 746 individuals born from 1977 to 2016 (15 548 born VPT and 10 198 at term). In the 61 cohorts assessed at age 4 to 7 years (13 842 children born between 1977 and 2014 [8847 born VPT and 4995 at term]; mean [SD] GA, 28.2 [1.7] weeks for the VPT cohorts), IQ was lower for VPT-born children compared with term-born children (SMD = −0.88; 95% CI, −0.97 to −0.79). The linear model showed no association with birth year (β = −0.002; 95% CI,−0.012 to 0.008). Three types of nonlinear models were fit, with no nonlinear associations observed. Adjustment for GA and study characteristics did not change the results (β = −0.001; 95% CI, −0.013 to 0.011). Secondary analysis of 131 cohorts found a similar difference between VPT and term groups (SMD = −0.84; 95% CI, −0.90 to −0.79), with no time trend (β = 0.001; 95% CI, −0.005 to 0.007).Conclusions and RelevanceOn average, children born VPT had significantly lower IQ scores than term-born children, and this deficit did not decrease in studies conducted over 4 decades.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"144 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715330","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":"Change to Open Access Status.","authors":"","doi":"10.1001/jamapediatrics.2025.2389","DOIUrl":"10.1001/jamapediatrics.2025.2389","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Results.","authors":"","doi":"10.1001/jamapediatrics.2025.2421","DOIUrl":"10.1001/jamapediatrics.2025.2421","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bedside Technologies to Challenge Traditional Rib Counting in Neonatal Respiratory Care.","authors":"Thomas M Raffay,Charles C Roehr,Richard J Martin","doi":"10.1001/jamapediatrics.2025.2105","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2105","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"42 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669547","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":"Glucagon-Like Peptide-1 Receptor Agonists and Youth Obesity.","authors":"Emma K Edmondson,Rachana D Shah,Emily F Gregory","doi":"10.1001/jamapediatrics.2025.2077","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2077","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669544","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":"The Moral Injury of Denying Gender-Affirming Care.","authors":"Scott K Jelinek","doi":"10.1001/jamapediatrics.2025.2116","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2116","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"14 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669545","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":"Diaphragm Position on Chest Radiograph to Estimate Lung Volume in Neonates.","authors":"Sophia I Dahm,Arun Sett,Emma F Gunn,Fiona Ramanauskas,Richard Hall,David Stewart,Sienna Koeppenkastrop,Kieran McKenna,Rebecca E Gardiner,Padma Rao,David G Tingay","doi":"10.1001/jamapediatrics.2025.2108","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2108","url":null,"abstract":"ImportanceUsing chest radiographs to guide lung aeration during respiratory support in infants is common practice and recommended in neonatal intensive care unit (NICU) guidelines, but this practice has never been validated.ObjectiveTo describe the association between diaphragm position on chest radiograph in infants and aerated lung volume calculated from computed tomography (CT).Design, Setting, and ParticipantsThis was a retrospective cross-sectional study conducted at a tertiary children's hospital, the Royal Children's Hospital, in Melbourne, Australia. Included were infants without congenital lung pathology who received a chest CT in the first 30 days after birth between July 9, 2012, to December 31, 2022; infant data were retrieved from the Royal Children's Hospital Medical Imaging database. Study data were analyzed from December 2022 to September 2023.ExposureLung volume was calculated using CT semiautomated tissue segmentation and diaphragm position determined using a standardized definition. All investigators analyzing CTs were unaware of the chest radiograph measurements and vice versa.Main Outcomes and MeasuresThe primary outcome was the distribution and precision of total lung volume at each of the measured diaphragm positions (6th-11th posterior rib).ResultsThe imaging data of 218 infants (median [IQR] age, 11 [3-20] days old; mean [SD] age, 37.9 [1.9] weeks' gestation at birth; 119 male [55%]) were analyzed. Infants had a mean (SD) weight of 3055 (584) g at scan, and 132 (61%) had a primary cardiac diagnosis. The number of posterior ribs representing diaphragm position ranged from 6 to 11. There was only a weak association between diaphragm position and lung volume (Kendall τ = 0.23; 95% CI, 0.16-0.31). A similar weak association was observed by hemithorax (left, Kendall τ = 0.25; 95% CI, 0.15-0.34; right, Kendall τ = 0.21; 95% CI, 0.10-0.31), degree of consolidation (Kendall τ = 0.30; 95% CI, 0.21-0.38), apex-diaphragm distance (Kendall τ = 0.40; 95% CI, 0.28-0.51), and Hounsfield unit values (Kendall τ = -0.05; 95% CI, -0.15 to -0.06).Conclusions and RelevanceResults of this cross-sectional study suggest that despite long-standing acceptance in the NICU, the use of diaphragm position on chest radiograph lacked the precision required to assess aerated lung volume and guide clinical practice in infants.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"22 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669543","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}