JAMA Pediatrics最新文献

{"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}

{"title":"Deferred Cord Clamping With High Oxygen in Extremely Preterm Infants: A Randomized Clinical Trial.","authors":"Anup C Katheria,Felix Ines,Henry C Lee,Christina Sollinger,Payam Vali,Ana Morales,Shashank Sanjay,Rebecca Dorner,Jenny Koo,Yvonne Gollin,Abhik Das,Debra Poeltler,Robin Steinhorn,Neil Finer,Satyan Lakshminrusimha","doi":"10.1001/jamapediatrics.2025.2128","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2128","url":null,"abstract":"ImportanceDeferred cord clamping (DCC) with high oxygen may reduce early hypoxia in preterm newborns. However, the safety and efficacy of this procedure has never been studied.ObjectiveTo determine whether providing 100% oxygen by face mask during the window of DCC in preterm infants reduces hypoxemia compared with 30% oxygen without hyperoxemia due to the continued mixing with umbilical venous blood.Design, Setting, and ParticipantsThis double-blinded randomized clinical trial took place from November 2021 to October 2024 at 2 universities and 1 private medical center in California. Participants included 140 preterm infants (born at 22 to 28 weeks' gestation). These data were analyzed from November 2024 to May 2025.InterventionsDuring DCC, infants received continuous positive airway pressure or positive pressure ventilation via face mask and were randomized to either 30% (low oxygen group) or 100% (high oxygen group) using a concealed blender. After the umbilical cord was clamped and cut, each infant was resuscitated per contemporary guidelines (30% oxygen and titration based on saturation of peripheral oxygen).Main OutcomeThe primary outcome was the number of infants who achieve peripheral oxygen saturations of 80% by 5 minutes of life.ResultsThere were 140 infants randomized (mean gestational age, 26 weeks; 69 female [49%] and 71 male [51%]). In the low oxygen group, 28 of 72 infants (39%) achieved a peripheral oxygen saturation of 80% by 5 minutes compared with 47 of 68 infants (69%) in the high oxygen group (adjusted odds ratio, 3.74; 95% CI, 1.80-7.79; P < .001). The absolute risk difference between the 2 groups was 0.3 (95% CI, 0.26-0.35), indicating that the high oxygen group had a 30% lower risk of experiencing hypoxemia 5 minutes after birth. Maximum median fraction of inspired oxygen during resuscitation after DCC, umbilical arterial partial pressure of oxygen in arterial blood, severe intraventricular hemorrhage, and death before 40 weeks' postmenstrual age were not different between groups.Conclusion and RelevanceIn this study, 100% oxygen during DCC reduced early hypoxemia without increased morbidity. A large randomized clinical trial is needed to determine if 100% oxygen during DCC improves survival and reduces longer-term morbidities in extremely preterm infants.Trial RegistrationClinicalTrials.gov Identifier: NCT04413097.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669546","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":"Limitations in the Evaluation of Neonatal Intensive Care.","authors":"Siyuan Jiang,Henry C Lee","doi":"10.1001/jamapediatrics.2025.2035","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2035","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"45 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622184","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":"Pediatric Airway Biology and Transcriptomic Assessment of Therapies.","authors":"Gustavo Nino,Jose L Gomez,Maria J Gutierrez","doi":"10.1001/jamapediatrics.2025.2070","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2070","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"2 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622013","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":"Inflammatory Pathways in Residual Asthma Exacerbations Among Mepolizumab-Treated Urban Children: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Matthew C Altman,Tomasz Janczyk,Ryan C Murphy,Naresh Doni Jayavelu,Agustin Calatroni,Meyer Kattan,Michelle A Gill,Jeffrey Stokes,Andrew H Liu,Gurjit K Khurana Hershey,Michael Sherenian,Rajesh Kumar,Rachel G Robison,Rebecca S Gruchalla,George T O'Connor,Edward M Zoratti,Stephen J Teach,Susan V Lynch,Kimberly A Dill-McFarland,Patrice M Becker,Alkis Togias,James E Gern,Leonard B Bacharier,William W Busse,Daniel J Jackson, ","doi":"10.1001/jamapediatrics.2025.2044","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2044","url":null,"abstract":"ImportanceWhile biologic therapies targeting type 2 (T2) inflammation reduce acute exacerbation rates in children with asthma and T2 inflammation, exacerbations still occur, and the underlying molecular mechanisms are poorly defined.ObjectiveTo identify multiple distinct molecular mechanisms implicated in asthma exacerbations by characterizing respiratory illnesses among urban children with eosinophilic asthma enrolled in a clinical trial comparing treatment with mepolizumab vs placebo.Design, Setting, and ParticipantsThis is a secondary analysis of the Mechanisms Underlying Asthma Exacerbations Prevented and Persistent With Immune-Based Therapy: A Systems Approach Phase 2 (MUPPITS-2) double-blind, placebo-controlled, parallel-group, randomized clinical trial comparing treatment with mepolizumab vs placebo among children with exacerbation-prone asthma in low-income urban centers in 9 US cities. Data analysis was performed from September 2022 to April 2025.InterventionParticipants were randomized to receive either mepolizumab (aged 6-11 years: 40 mg; aged 12-17 years: 100 mg) or matching placebo by subcutaneous injection once every 4 weeks for 52 weeks.Main Outcomes and MeasuresThe primary measurement was a transcriptomic modular analysis by RNA sequencing of nasal samples obtained during acute respiratory illnesses. Associations among upper airway transcriptional signatures, the clinical outcome of respiratory illnesses, and pulmonary functions were investigated.ResultsOf the 290 participants enrolled in the MUPPITS-2 trial, 108 participants (median [IQR] age, 10.0 [9.0-13.0] years; 48 [44%] female) were sampled during 176 acute respiratory illness events. During illness events resulting in asthma exacerbations, children receiving mepolizumab demonstrated decreased expression of an eosinophil-associated module associated with T2 inflammation (log2 fold change [FC] estimate, -0.60; false discovery rate [FDR] &lt; .05) but increased expression of gene modules associated with epithelial and macrophage inflammatory pathways relative to children receiving placebo (log2 FC estimates, 0.22-0.85; FDR &lt; .05). Both groups showed higher expression of mucus secretion and cellular stress response pathways during exacerbations relative to nonexacerbation illnesses. The mepolizumab group demonstrated upregulation of epithelial inflammatory pathways in exacerbations irrespective of a respiratory virus, while macrophage pathways contributed specifically to viral exacerbations. Three distinct, semiorthogonal inflammatory axes were shown to underlie the majority of the heterogeneity among exacerbations in the 2 groups.Conclusions and RelevanceThe study's findings implicate multiple alternative inflammatory pathways associated with the epithelium and macrophages, as well as mucus hypersecretion, as mechanisms of residual acute exacerbations in children receiving mepolizumab. Further, they indicate that multiple distinct inflammatory axes can independently contribute to","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"280 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622192","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":"Limitations in the Evaluation of Neonatal Intensive Care.","authors":"Ayman El-Mohandes,Paul Barach","doi":"10.1001/jamapediatrics.2025.2032","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2032","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622185","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":"Preserving Pediatric Best Practice in Challenging Times.","authors":"Meredithe McNamara,Adam Kronish,Danny Birkhead,Jamie Mehringer","doi":"10.1001/jamapediatrics.2025.2038","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2038","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"23 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622193","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":"Limitations in the Evaluation of Neonatal Intensive Care-Reply.","authors":"Gwenyth M Gasper,Therese A Stukel,David C Goodman","doi":"10.1001/jamapediatrics.2025.2041","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2041","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"151 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622183","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 Reassuring and Misleading Myth of Familial Short Stature.","authors":"Gianluca Tamaro,Alice Fachin,Gianluca Tornese","doi":"10.1001/jamapediatrics.2025.1880","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.1880","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568335","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}