JAMA Pediatrics最新文献

{"title":"Removable Boot vs Casting of Toddler’s Fractures","authors":"Ariane Boutin, Keith Colaco, Jennifer Stimec, Mark Camp, Unni Narayanan, Maala Bhatt, Naveen Poonai, Andrew R. Willan, Ramona Cook, Marie-Lyne Nault, Sasha Carsen, Kathy Boutis","doi":"10.1001/jamapediatrics.2025.0560","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0560","url":null,"abstract":"ImportanceToddler’s fractures (TF) of the tibia are commonly treated with casts and fracture clinic follow-up. However, a prefabricated removable boot might be sufficient and reduce unnecessary follow-up.ObjectivesTo determine whether pain in children with TF treated with a removable boot is not worse than those managed with a circumferential cast at 4 weeks postinjury.Design, Setting, and ParticipantsThis pragmatic, multicenter, assessor-blinded, noninferiority randomized clinical trial was conducted between October 2019 and February 2024 at 4 urban, tertiary care, pediatric Canadian emergency departments. Children aged between 9 months and 4 years with a radiograph-visible TF were eligible for inclusion.InterventionsPrefabricated walking boot for up to 3 weeks (removable at caregivers’ discretion) vs circumferential cast immobilization (site standard of care) for 3 weeks.Main Outcomes and MeasureThe primary outcome was pain score, measured with the Evaluation Enfant Douleur (EVENDOL) scale (maximum score: 15). Additional outcomes included return to baseline activities, complications, parental satisfaction and care burden.ResultsIn 129 enrolled children, the mean (SD) age was 2.2 (0.8) years, and 56 children (43%) were female. Of these, 118 children (92%) completed the 4-week follow-up, and the boot (n = 64) vs cast (n = 54) groups demonstrated mean (SD) EVENDOL pain scores of 1.21 (1.54) and 1.76 (2.13), respectively (difference, −0.55; 95% CI, −1.23 to 0.13). The percentage of participants who returned to baseline activities “almost all of the time” was 49 of 64 children (77%) in the boot group and 22 of 54 (41%) in the cast group (difference, 36%; 95% CI, 9%-63%). Skin complications occurred in both groups (boot: 46 total complications [72%], with 5 stage 1 pressure sores; cast: 27 total complications (50%), with 1 pressure sore]; difference, 22%; 95% CI, −6% to 50%). There was no statistically significant difference in the percentage of caregivers who were satisfied or very satisfied with the treatment (difference, 9%; 95% CI, −24% to 43%). Fewer caregivers reported bathing care burden (difference, −32%; 95% CI, −47% to −18%) and challenges with carrying the child (difference, −21%; 95% CI, −27% to −15%) in the boot vs cast group.Conclusions and RelevanceIn this multicenter randomized clinical trial examining the management of children with TF, a removable boot without physician follow-up was noninferior to circumferential casting with respect to pain recovery. While there was a clinically relevant but not statistically significant trend toward more skin complications in the boot group, there was no difference in caregiver satisfaction, and the boot strategy demonstrated reduced childcare-related challenges.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.clinicaltrials.gov/study/NCT03971448?cond=NCT03971448&rank=1\">NCT03971448</","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"23 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853498","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":"Genomic and Developmental Models to Predict Cognitive and Adaptive Outcomes in Autistic Children","authors":"Vincent-Raphaël Bourque, Zoe Schmilovich, Guillaume Huguet, Jade England, Adeniran Okewole, Cécile Poulain, Thomas Renne, Martineau Jean-Louis, Zohra Saci, Xinhe Zhang, Thomas Rolland, Aurélie Labbé, Jacob Vorstman, Guy A. Rouleau, Simon Baron-Cohen, Laurent Mottron, Richard A. I. Bethlehem, Varun Warrier, Sébastien Jacquemont","doi":"10.1001/jamapediatrics.2025.0205","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0205","url":null,"abstract":"ImportanceAlthough early signs of autism are often observed between 18 and 36 months of age, there is considerable uncertainty regarding future development. Clinicians lack predictive tools to identify those who will later be diagnosed with co-occurring intellectual disability (ID).ObjectiveTo predict ID in children diagnosed with autism.Design, Setting, and ParticipantsThis prognostic study involved the development and validation of models integrating genetic variants and developmental milestones to predict ID. Models were trained, cross-validated, and tested for generalizability across 3 autism cohorts: Simons Foundation Powering Autism Research (SPARK), Simons Simplex Collection, and MSSNG. Autistic participants were assessed older than 6 years of age for ID. Study data were analyzed from January 2023 to July 2024.ExposuresAges at attaining early developmental milestones, occurrence of language regression, polygenic scores for cognitive ability and autism, rare copy number variants, de novo loss-of-function and missense variants impacting constrained genes.Main Outcomes and MeasuresThe out-of-sample performance of predictive models was assessed using the area under the receiver operating characteristic curve (AUROC), positive predictive values (PPVs), and negative predictive values (NPVs).ResultsA total of 5633 autistic participants (4574 male [81.2%]) were included in this analysis. On average, participants were diagnosed with autism at 4 (IQR, 3-7) years of age and assessed for ID at 11 (8-14) years of age, with 1159 participants (20.6%) being diagnosed with ID. The model integrating all predictors yielded an AUROC of 0.653 (95% CI, 0.625-0.681), and this predictive performance was cross-validated and generalized across cohorts. This modest performance reflected that only a subset of individuals carried large-effect variants, high polygenic scores, or presented delayed milestones. However, combinations of genetic variants that are typically not considered clinically relevant by diagnostic laboratories achieved PPVs of 55% and correctly identified 10% of individuals developing ID. The addition of polygenic scores to developmental milestones specifically improved NPVs rather than PPVs. Notably, the ability to stratify ID probabilities using genetic variants was up to 2-fold higher in individuals with delayed milestones compared with those with typical development.Conclusions and RelevanceResults of this prognostic study suggest that the growing number of neurodevelopmental condition–associated variants cannot, in most cases, be used alone for predicting ID. However, models combining different classes of variants with developmental milestones provide clinically relevant individual-level predictions that could be useful for targeting early interventions.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"7 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853495","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":"Epidemiology and Mortality of Invasive Staphylococcus aureus Infections in Hospitalized Infants","authors":"Maria Rain Jennings, Nora Elhaissouni, Elizabeth Colantuoni, Erica C. Prochaska, Julia Johnson, Shaoming Xiao, Reese H. Clark, Rachel G. Greenberg, Daniel K. Benjamin, Aaron M. Milstone","doi":"10.1001/jamapediatrics.2025.0429","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0429","url":null,"abstract":"ImportanceHistorically, <jats:italic>Staphylococcus aureus</jats:italic> has been a leading cause of morbidity and mortality in the neonatal intensive care unit (NICU). The current incidence and attributable mortality of late-onset invasive <jats:italic>S aureus</jats:italic> infection in hospitalized infants is unknown.ObjectiveTo estimate the incidence and attributable mortality of late-onset <jats:italic>S aureus</jats:italic> infection among hospitalized infants in the US.Design, Setting, and ParticipantsThis retrospective cohort study included an emulated trial among a national convenience sample of 315 NICUs within the US between 2016 and 2021. Participants were infants aged at least 4 postnatal days who were hospitalized in a participating NICU. Data were analyzed from May to August 2024.ExposuresThe primary exposures were birth weight and postnatal age.Main Outcomes and MeasuresThe outcomes were the incidence and attributable mortality of late-onset invasive <jats:italic>S aureus</jats:italic> infection. Methicillin-resistant and methicillin-sensitive <jats:italic>S aureus</jats:italic> classification was not universally available; thus, all invasive <jats:italic>S aureus</jats:italic> infections were pooled.ResultsFrom 468 201 infants (260 491 [55.6%] male; median [IQR] gestational age, 36 [33-38] weeks) eligible for analysis, 1724 infants experienced 1762 infections for an overall incidence of 37.6 (95% CI, 35.9-39.4) invasive <jats:italic>S aureus</jats:italic> infections per 10 000 infants. Most infants with invasive infections were 32 weeks’ gestational age or younger (1394 infants [80.9%]), very low birth weight (VLBW; ie, &amp;amp;lt;1500 g) (1318 infants [76.5%]), and/or had a central line during their hospital stay (1509 infants [87.5%]). Invasive infections mostly included bloodstream infections (1505 infections [85.4%]), and 1160 infections (65.8%) occurred within 4 to 28 postnatal days. Birth weight inversely correlated with incidence: infants with VLBW experienced a more than 20-fold higher incidence relative to infants born weighing at least 1500 g (227.1 [95% CI, 215.3-239.4] vs 10.1 [95% CI, 9.1-11.1] infections per 10 000 infants). Most deaths following invasive infection occurred among VLBW infants (189 of 209 deaths [90.4%]). Compared with matched infants without a late-onset invasive <jats:italic>S aureus</jats:italic> infection, infected infants had an absolute difference in mortality rate of 5.3% (95% CI, 3.8%-6.8%).Conclusions and RelevanceThis cohort study found late-onset invasive <jats:italic>S aureus</jats:italic> infection and subsequent attributable mortality disproportionally affected infants with VLBW. Targeted infection prevention and control measures are necessary to reduce morbidity and mortality from invasive <jats:italic>S aureus</jats:italic> infections in this vulnerable population.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"20 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827732","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":"Is Staphylococcus Aureus Still a Problem in the Neonatal Intensive Care Unit?","authors":"Lakshmi Srinivasan,David A Kaufman","doi":"10.1001/jamapediatrics.2025.0437","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0437","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"17 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831808","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":"Patterns in Nonfatal Self-Harm Among Adolescents.","authors":"Emily F Liu,Ellicott C Matthay,Kriszta Farkas,Jennifer Ahern","doi":"10.1001/jamapediatrics.2025.0283","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0283","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"85 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831806","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":"Awareness of Adverse Obstetric Outcomes in All Types of Fetal Congenital Heart Defects-Reply.","authors":"Gitte Hedermann,Michael Christiansen,Charlotte K Ekelund","doi":"10.1001/jamapediatrics.2025.0363","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0363","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831632","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":"Adolescent Disparities in Exposure to Adverse Childhood Experiences by Gender Identity.","authors":"Noah T Kreski,Katherine M Keyes","doi":"10.1001/jamapediatrics.2025.0449","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0449","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"218 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831807","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":"Prevalence of Motor Milestone Delays in Autistic Children","authors":"Olivia M. Pokoski, Sarah M. Furnier, Ronald E. Gangnon, Ellen M. Howerton, Anne V. Kirby, Tyra Protho, Marin L. Schweizer, Brittany G. Travers, Maureen S. Durkin","doi":"10.1001/jamapediatrics.2025.0216","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0216","url":null,"abstract":"ImportancePrior literature has explored the prevalence of motor impairments in autistic individuals, but estimates come from clinical, convenience, or small samples, limiting generalizability. Better understanding of the frequency of motor milestone delays in autistic individuals could improve early identification and subsequently lead to earlier intervention and better developmental outcomes.ObjectiveTo determine the prevalence of motor milestone delays in a population-based sample of 8-year-old autistic children and to evaluate if having motor milestone delays is associated with an earlier age at autism evaluation or diagnosis.Design, Setting, and ParticipantsThis cross-sectional study of autistic 8-year-old children was conducted using Autism and Developmental Disabilities Monitoring (ADDM) Network data between surveillance years 2000 and 2016. ADDM Network data are population based and are drawn from 17 sites across the US. Data were analyzed from October 2023 to August 2024.ExposureBinary indicator of motor milestone delays documented in health or educational records.Main Outcomes and MeasuresThe primary outcome was the prevalence of motor milestone delays among autistic 8-year-old children. Associations between motor milestone delays and age at autism evaluation or diagnosis were evaluated using linear regression. Covariates included study site, surveillance year, the number of autism discriminators, intellectual disability, child sex, and child race and ethnicity.ResultsAmong 32 850 children aged 8 years identified with autism by active surveillance, 23 481 children (71.5%) met criteria for motor milestone delays. A total of 5973 children (18.2%) were female. In linear regression models, children with motor milestone delays were evaluated for autism significantly earlier (mean age, 43.65 months; 95% CI, 43.38-43.91) than children without motor milestone delays (mean age, 51.64 months; 95% CI, 51.22-52.06). After stratifying by the co-occurrence of intellectual disability (ID), children with motor milestone delays were evaluated for autism earlier than those without motor milestone delays, regardless of ID.Conclusions and RelevanceThis cross-sectional study estimates the prevalence of motor milestone delays among autistic 8-year-old children and highlights the association between these delays and an earlier autism evaluation, even in children without co-occurring ID. Early identification of autism is a public health priority, and assessing motor milestone delays, particularly in children with an increased likelihood of being autistic, may facilitate an earlier autism evaluation, leading to more timely interventions and better developmental outcomes.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"108 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827727","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":"Awareness of Adverse Obstetric Outcomes in All Types of Fetal Congenital Heart Defects.","authors":"Maartje C Snoep,Lotte E van der Meeren,Monique C Haak","doi":"10.1001/jamapediatrics.2025.0366","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0366","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"6 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831642","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":"Implications of Abortion Restrictions for Adolescents","authors":"Laura D. Lindberg, Julie Maslowsky, Paz Baum","doi":"10.1001/jamapediatrics.2025.0226","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0226","url":null,"abstract":"This cross-sectional study examines the proportion of the adolescent population potentially facing barriers to abortion access owing to 3 types of state restrictions in the US.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"102 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790161","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}