JAMA Pediatrics最新文献

Pharmacologic Management of Acute Pain in Children

IF 26.1 1区医学

JAMA Pediatrics Pub Date : 2025-02-03 DOI: 10.1001/jamapediatrics.2024.5920

Laura Olejnik, João Pedro Lima, Behnam Sadeghirad, Jason W. Busse, Ivan D. Florez, Samina Ali, James Bunker, Danny Jomaa, Adam Bleik, Mohamed Eltorki

{"title":"Pharmacologic Management of Acute Pain in Children","authors":"Laura Olejnik, João Pedro Lima, Behnam Sadeghirad, Jason W. Busse, Ivan D. Florez, Samina Ali, James Bunker, Danny Jomaa, Adam Bleik, Mohamed Eltorki","doi":"10.1001/jamapediatrics.2024.5920","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5920","url":null,"abstract":"ImportanceSeveral pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain.ObjectiveTo assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials.Data SourcesCochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023.Study SelectionTrials that enrolled children (aged &amp;lt;18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included.Data Extraction and SynthesisPairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach.Main OutcomesThe primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events.ResultsA total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], −1.29; 95% CI, −1.89 to −0.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, −1.12; 95% CI, −2.09 to −0.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, −1.19; 95% CI, −1.83 to −0.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low/very low–certainty evidence.Conclusions and RelevanceCompared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"166 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077382","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}

引用次数: 0

Adolescent Smartphone Use During School Hours.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-02-03 DOI: 10.1001/jamapediatrics.2024.6627

Dimitri A Christakis, Gina Marie Mathew, David A Reichenberger, Isaac R Rodriguez, Benny Ren, Lauren Hale

引用次数: 0

Maternal and Child Health Following 2 Home Visiting Interventions vs Control

IF 26.1 1区医学

JAMA Pediatrics Pub Date : 2025-02-03 DOI: 10.1001/jamapediatrics.2024.5929

Marie Lisanne Schepan, Malte Sandner, Gabriella Conti, Sören Kliem, Tilman Brand

{"title":"Maternal and Child Health Following 2 Home Visiting Interventions vs Control","authors":"Marie Lisanne Schepan, Malte Sandner, Gabriella Conti, Sören Kliem, Tilman Brand","doi":"10.1001/jamapediatrics.2024.5929","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5929","url":null,"abstract":"ImportanceHome-based interventions targeting socially disadvantaged families may help to improve maternal and child health. Only a few studies have investigated how different staffing models affect early home visiting program outcomes.ObjectiveTo assess the effects of 2 staffing models of an early childhood intervention on mother and child outcomes.Design, Setting, and ParticipantsThe baseline assessment of this randomized trial was conducted between November 2006 and December 2009 in 15 municipalities in Germany. The follow-up assessment at offspring age 7 years was carried out by interviewers masked to treatment conditions from April 2015 to December 2017. Data analysis was performed from March to August 2023. Pregnant women with no previous live birth, low-income, and at least 1 additional psychosocial risk factor were eligible. A total of 1157 women were referred to the study by gynecologists, psychosocial counseling services, or employment agencies; 755 were randomized to treatment conditions (2 intervention groups and 2 control groups); and 525 completed the follow-up.InterventionsBased on the Nurse-Family Partnership program, women assigned to the intervention groups received visits by either a midwife (midwife-only model) or by a team consisting of a social worker and a midwife (tandem model) until child age 2 years. Women assigned to control groups had access to the standard health and social services.Main Outcomes and MeasuresAverage treatment effects (ATEs) on the following primary outcomes were assessed using adjusted regression models with inverse probability weighting: developmental disorders, child behavioral problems, adverse, neglectful and abusive parenting, maternal mental health, and life satisfaction.ResultsThe mean (SD) age at follow-up was 29.6 (4.36) years for mothers and 7.55 (0.75) years for children; 272 (52.2%) of the children were female. Mothers in the tandem model reported fewer internalizing child behavioral problems compared to their control group (ATE, 2.98; 95% CI, −5.49 to −0.47; absolute reduction, 13.3 percentage points). Beneficial intervention effects were found in the midwife-only group on abusive parenting (ATE, −4.00; 95% CI, −6.82 to −1.18), parenting stress (ATE, −0.13; 95% CI, −0.20 to −0.06), and maternal mental health burden (ATE, −3.63; 95% CI, −6.03 to −1.22; absolute reduction, 6.6 percentage points in depressive symptoms), but not in the tandem group.Conclusions and RelevanceBoth staffing models produced positive intervention effects, with more effects seen in the midwife-only model. These insights can guide future early childhood intervention designs and may help improve health care for socially disadvantaged families.Trial RegistrationGerman Clinical Trials Register Identifier: DRKS00007554","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"21 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076825","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}

引用次数: 0

Pediatric Readiness and Trauma Center Access for Children

IF 26.1 1区医学

JAMA Pediatrics Pub Date : 2025-02-03 DOI: 10.1001/jamapediatrics.2024.6058

Caroline Melhado, Canaan Hancock, Haoyu Wang, Maya M. Eldin, Nicholas George, Jennifer A. Miller, Katherine E. Remick, Bhavin Patel, Brian K. Yorkgitis, Lisa Gray, Michael W. Dingeldein, Hilary A. Hewes, Katie W. Russell, Michael L. Nance, Aaron R. Jensen

{"title":"Pediatric Readiness and Trauma Center Access for Children","authors":"Caroline Melhado, Canaan Hancock, Haoyu Wang, Maya M. Eldin, Nicholas George, Jennifer A. Miller, Katherine E. Remick, Bhavin Patel, Brian K. Yorkgitis, Lisa Gray, Michael W. Dingeldein, Hilary A. Hewes, Katie W. Russell, Michael L. Nance, Aaron R. Jensen","doi":"10.1001/jamapediatrics.2024.6058","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6058","url":null,"abstract":"ImportanceChildren initially treated in a timely fashion at trauma centers with high levels of pediatric readiness have been shown to have improved survival, but children historically have had geographically disparate access to pediatric trauma center care. Considerable effort has been invested in improving pediatric readiness nationally, including the implementation of new standards to improve emergency department pediatric readiness at all trauma centers.ObjectiveTo assess current access to US pediatric-ready trauma center care and to estimate potential improvement in access if all high-level trauma centers had optimal pediatric readiness.Design, Setting, and ParticipantsThis descriptive cross-sectional study collated trauma centers from national organizational lists, state government websites, and online searches. A geospatial analysis was performed of access by pediatric patients (aged ≤18 years) to trauma centers by ground or air ambulance within 60 minutes, stratified by trauma center type and pediatric readiness status. Population density was estimated using 2020 US census data. Weighted pediatric readiness scores (wPRS) were obtained from the 2021 National Pediatric Readiness Project assessment. The data analysis was performed between April 1 and June 30, 2023.ExposureAccess times to trauma centers.Main Outcome and MeasureThe main outcome of interest was access to a pediatric-ready trauma center, defined as a high-level pediatric trauma center (level I-II) or high-level adult trauma center (level I-III) with a wPRS of at least 93 (out of 100). Access times were calculated using previously validated methods and service network model analysis for each trauma center to census block group centroid.ResultsThe analysis included 148 pediatric and 1075 high-level adult trauma centers. A total of 273 adult centers (25%) were pediatric ready. Pediatric trauma center access within 60 minutes by ground or air ambulance was available for 65% of all 74 090 665 children; 73% of children had access to a pediatric-ready trauma center within 60 minutes, and 92% had access to any high-level trauma center within 60 minutes.ConclusionThese findings suggest that access to pediatric trauma center care is limited, even with air ambulance transport. Ensuring pediatric readiness at all high-level adult trauma centers may substantially improve access to early high-quality initial resuscitative trauma care for children.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077381","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}

引用次数: 0

Policies and Regulations Regarding Adolescent Marijuana Use.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-02-03 DOI: 10.1001/jamapediatrics.2024.6584

Ling Zhang, Jun Li, Yaling Li

引用次数: 0

Policies and Regulations Regarding Adolescent Marijuana Use-Reply.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-02-03 DOI: 10.1001/jamapediatrics.2024.6587

Li Wang, Jason W Busse

引用次数: 0

Long COVID Prevalence and Associated Activity Limitation in US Children 美国儿童中长期 COVID 患病率及相关活动限制