JAMA Pediatrics最新文献

{"title":"COVID-19 Pandemic and the Developmental Health of Kindergarteners.","authors":"Judith L Perrigo, Jordan Morales, Nicholas Jackson, Magdalena Janus, Lisa Stanley, Mitchell Wong, Neal Halfon","doi":"10.1001/jamapediatrics.2024.7057","DOIUrl":"10.1001/jamapediatrics.2024.7057","url":null,"abstract":"<p><strong>Importance: </strong>Recent studies have associated the COVID-19 pandemic with negative developmental outcomes in children. However, research focused on young children remains limited, with few studies including multiple years of pre- and postpandemic onset data.</p><p><strong>Objective: </strong>To examine the impact of the COVID-19 pandemic on US kindergarteners' developmental health.</p><p><strong>Design, setting, and participants: </strong>This repeated cross-sectional panel study examined developmental health trends, as measured by the Early Development Instrument (EDI), among a convenience sample US kindergarteners from 2010 to 2023. EDI data were obtained from 390 school districts across 19 states. Data were analyzed from June December 2024.</p><p><strong>Exposure: </strong>Kindergarteners' developmental health was compared between prepandemic (2018 to 2020) and postpandemic (2021 to 2023) onset cohorts.</p><p><strong>Main outcomes and measures: </strong>Outcomes were EDI scores across time in 5 domains: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. The mean (95% CI) EDI scores were assessed.</p><p><strong>Results: </strong>In this sample of of 475 740 US kindergarten students, 242 869 were male (51.1%), there were 53 841 African American or Black students (11.4%), 263 037 Hispanic or Latino/a students (55.5%), and 95 258 White students (20.1%), and the mean (SD) age was 6 (0.4) years (range, 4.0-8.0 years). Compared with the immediate prepandemic onset period, the rate of change in EDI scores was significantly lower following the pandemic onset in language and cognitive development (mean change, -0.45; 95% CI, -0.48 to -0.43), social competence (mean change, -0.03; 95% CI, -0.06 to -0.01), and communication and general knowledge (mean change, -0.18; 95% CI, -0.22 to -0.15). EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03 to 0.07), and no significant changes were observed in the physical health and well-being domain (mean change, 0; 95% CI, -0.01 to 0.02).</p><p><strong>Conclusions and relevance: </strong>The COVID-19 pandemic was associated with varying developmental health outcomes in kindergarteners. Negative developmental trends existed immediately before the pandemic, with most persisting or slowing postpandemic onset. These results highlight troubling trends in kindergarteners' development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"550-558"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585714","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":"What Parents Should Understand About Growth in Children.","authors":"Elizabeth T Walsh, Lindsay A Thompson","doi":"10.1001/jamapediatrics.2024.7091","DOIUrl":"10.1001/jamapediatrics.2024.7091","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"584"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752885","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":"SARS-CoV-2 Infection and Childhood Islet Autoimmunity.","authors":"Gregory J Walker, Kylie-Ann Mallitt, Maria E Craig, Pat Ashwood, Simon C Barry, James D Brown, Joanna Caguicla, Elizabeth A Davis, Emma E Hamilton-Williams, Leonard C Harrison, Aveni Haynes, Tony Huynh, Guinevere Martin, Kelly J McGorm, Grant Morahan, Zin Naing, Helena Oakey, Megan A S Penno, Andrea Sevendal, Richard O Sinnott, Georgia Soldatos, Rebecca L Thomson, Jason Tye-Din, Peter J Vuillermin, Emily J Ward, John M Wentworth, Peter G Colman, Jennifer J Couper, Ki Wook Kim, William D Rawlinson","doi":"10.1001/jamapediatrics.2024.6848","DOIUrl":"10.1001/jamapediatrics.2024.6848","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"568-570"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542037","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":"Age Decomposition of Mortality Rates Among Children Younger Than 5 Years in 47 LMICs.","authors":"Omar Karlsson, Thomas W Pullum, Akhil Kumar, Rockli Kim, S V Subramanian","doi":"10.1001/jamapediatrics.2024.6908","DOIUrl":"10.1001/jamapediatrics.2024.6908","url":null,"abstract":"<p><strong>Importance: </strong>Despite a global decline in the mortality rate of children younger than 5 years (the under-5 mortality rate), neonatal deaths continue to present a substantial challenge. The etiology behind deaths varies between the early and late neonatal periods as well as at later ages.</p><p><strong>Objective: </strong>To decompose the under-5 mortality rate in 47 low- and middle-income countries into 8 age intervals, providing a comprehensive understanding of varying vulnerability across age groups.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used nationally representative data from 47 Demographic and Health Surveys conducted between 2014 and 2023 in low- and middle-income countries, including 1.4 million live births.</p><p><strong>Exposure: </strong>Age in days, weeks, months, or years.</p><p><strong>Main outcomes and measures: </strong>The under-5 mortality rate was decomposed by age based on a life table approach, using true cohort probabilities for the early and late neonatal periods and synthetic cohort probabilities for other age intervals, to obtain deaths per 1000 live births (ie, the cohort entering the life table) for each age interval.</p><p><strong>Results: </strong>In the pooled sample of 1 448 001 live births, there were 14 576 deaths in the early neonatal period (age 0 to 6 days); 3400 in the late neonatal period (age 7-27 days); 6760 in the early postneonatal period (age 28 days to 5 months); 4912 in the late postneonatal period (age 6-11 months); and 5145, 3990, 2674, and 1640 at ages 1, 2, 3, and 4 years, respectively. The early neonatal mortality rate accounted for 21.3 (95% CI, 20.5-22.1) deaths per 1000 births from a total under-5 mortality rate of 57.7 (95% CI, 56.2-59.3) deaths per 1000 births. The early neonatal mortality rate was significantly higher than mortality at subsequent ages (eg, median [IQR] mortality rates: early neonatal period, 18.8 [14.3-23.2] deaths per 1000 births; late neonatal period, 4.7 [3.1-5.9] deaths per 1000 births) and much higher when considering the average daily mortality rate. The early neonatal mortality rate accounted for the greatest share of under-5 mortality rate in all but 2 countries. In most countries the lowest mortality rates were observed at age 3 or 4 years. The share of deaths occurring in the late postneonatal period and later was greater in countries with greater under-5 mortality rates.</p><p><strong>Conclusions and relevance: </strong>The concentration of mortality in the first week after birth underscores a critical need for enhanced maternal and neonatal health care. Furthermore, early neonatal mortality rates should be routinely reported and included in health targets. In this study, the age of 6 months emerged as an important turning point: high-mortality countries were characterized by a greater concentration of deaths after age 6 months than countries with lower under-5 mortality rate.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"540-549"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585711","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":"Levels of Satisfaction and Regret Are Far From Settled.","authors":"Joanne Sinai, Chan Kulatunga-Moruzi, Sarah Jorgensen","doi":"10.1001/jamapediatrics.2025.0004","DOIUrl":"10.1001/jamapediatrics.2025.0004","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"579-580"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542034","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":"JAMA Pediatrics-The Year in Review 2024.","authors":"Dimitri A Christakis","doi":"10.1001/jamapediatrics.2025.0101","DOIUrl":"10.1001/jamapediatrics.2025.0101","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"494-495"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648554","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":"How Blood Pressure Tracks-Salty and Secondary Causes.","authors":"Federico Bernardo Rossi, Giulio Cabrelle, Giacomo Rossitto","doi":"10.1001/jamapediatrics.2025.0048","DOIUrl":"10.1001/jamapediatrics.2025.0048","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"581-582"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542032","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":"Opportunities and Needs to Advance Prevention of Substance Use Disorders.","authors":"Carlos Blanco, Nora D Volkow","doi":"10.1001/jamapediatrics.2025.0007","DOIUrl":"10.1001/jamapediatrics.2025.0007","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"487-488"},"PeriodicalIF":24.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542036","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":"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, &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .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: &lt;jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT04171999?term=NCT04171999&amp;amp;amp;rank=1\"&gt;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}