JAMA Pediatrics最新文献

{"title":"Prevalence of Obesity With Confirmed Excess Adiposity in US Children and Adolescents.","authors":"Alexandra B Palmer,Kyung Hyun Lee,Rashedeh Roshani,Elizabeth Frankel,Miryoung Lee,Mohammad Y Anwar,Heather M Highland,Kristin L Young,Mariaelisa Graff,Joseph B McCormick,Susan P Fisher-Hoch,Joyce P Samuel,Jennifer E Below,Kari E North,Penny Gordon-Larsen","doi":"10.1001/jamapediatrics.2025.2991","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2991","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"123 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008822","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":"Mortality Rate Trends for Sickle Cell Disease and Cystic Fibrosis in the US.","authors":"Hiluf Ebuy Abraha,Marie Thoma,Nansi S Boghossian","doi":"10.1001/jamapediatrics.2025.2997","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2997","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"43 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008833","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":"Cost-Effectiveness of Treatment for Opioid Use Disorder in Pregnancy and Its Impact on Birth Outcomes.","authors":"Ashley A Leech,Shawn Garbett,Hanxuan A Yu,Elizabeth McNeer,Rashmi Bharadwaj,Benjamin P Linas,John Graves,Jessica Young,Lisa Su,Peter R Martin,Michael J Ward,Mark N Ellingham,Katy B Kozhimannil,Lauren R Samuels,Jiayu Shi,Stephen W Patrick","doi":"10.1001/jamapediatrics.2025.3067","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3067","url":null,"abstract":"ImportanceFor the first time in nearly 2 decades, the US infant mortality rate has increased, coinciding with a rise in overdose-related deaths as a leading cause of pregnancy-associated mortality in some states. Prematurity and low birth weight-often linked to opioid use in pregnancy-are major contributors.ObjectiveTo assess the health and economic impact of perinatal opioid use disorder (OUD) treatment on maternal and postpartum health, infant health in the first year of life, and infant long-term health.Design, Setting, and ParticipantsThis was a cost-effectiveness, population-based analysis using a stochastic time-to-event discrete-event simulation model to simulate the clinical progression and outcomes for hypothetical pregnant individuals with OUD who initiate treatment during pregnancy. In addition, a scenario analysis was conducted assuming that individuals were stable taking OUD treatment before pregnancy and continued treatment during pregnancy. Data were analyzed from May to September 2024.ExposuresStudy exposures included outpatient methadone, buprenorphine monotherapy, and buprenorphine-naloxone; outpatient methadone, buprenorphine, and naltrexone after inpatient-managed withdrawal; and inpatient-managed withdrawal with and without an intensive behavioral component.Main Outcomes and MeasuresOutcomes included return to illicit use; fatal and nonfatal overdose; incremental discounted costs; quality-adjusted life-years (QALYs), which are a combined measure of mortality and morbidity; net health benefit; infant mortality within the first year of life; preterm birth; low birth weight; and neonatal opioid withdrawal syndrome (NOWS).ResultsIn this economic evaluation of a hypothetical cohort of 100 000 pregnant individuals (mean [SD] starting age, 29 [5.6] years), in the pregnancy and postpartum simulation, buprenorphine dominated all strategies, yet methadone was a viable alternative. In the combined infant lifetime model, compared with methadone, buprenorphine showed an incremental effect of 0.262 QALYs per person, totaling 20 960 QALYs for 80 000 Medicaid-affected mother-infant dyads (IQR uncertainty interval [UI] 25th to 75th percentiles, 14 880-27 040 QALYs); mean cost savings of $21 512 per person, totaling $1.72 billion (IQR UI, $1.46-1.98 billion). Compared with naltrexone, buprenorphine showed an incremental effect ranging from 0.228 to 0.229 QALYs per person; 18 240 of 18 320 total QALYs for 80 000 mother-infant dyads (IQR UI, 13 840-22 720 QALYs; naltrexone-oral; IQR UI, 13 760-22 880 QALYs; naltrexone-extended release [XR]). Mean cost savings ranged from $25 316 per person ($2.03 billion; IQR UI, $1.83-$2.21 billion; naltrexone-oral) to $46 437 per person ($3.71 billion; IQR UI, $3.47-$3.96 billion; naltrexone-XR).Conclusions and RelevanceResults of this analysis suggest that both methadone and buprenorphine remained viable options for managing OUD during pregnancy and post partum; however, buprenorphine offered the greatest ben","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"128 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008825","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":"Gonorrhea and Chlamydia Screening for Adolescents and Young Adults in Emergency Departments.","authors":"Jennifer L Reed,Chella A Palmer,T Charles Casper,Erin M Augustine,Andrea T Cruz,Cara L Elsholz,Cynthia J Mollen,Michelle L Pickett,Sarah K Schmidt,Kristin S Stukus,Monika K Goyal","doi":"10.1001/jamapediatrics.2025.2139","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2139","url":null,"abstract":"ImportanceAdolescents account for almost half of the 2.5 million diagnosed sexually transmitted infections in the US annually, and the emergency department functions as the primary source of health care for many adolescents. No recommendations exist for emergency department gonorrhea and chlamydia screening.ObjectiveTo compare usual care against targeted and universally offered gonorrhea and chlamydia screening approaches.Design, Setting, and ParticipantsThis was a comparative effectiveness, multicenter, pragmatic trial with a type 3 hybrid stepped-wedge crossover design implemented over approximately 20 months at 6 pediatric emergency departments in the US. Patients aged 15 to 21 years presenting to the emergency department between January 2021 and September 2022 were included, excluding those who were unable to understand English, were critically ill, were with concern for sexual assault or abuse, had cognitive impairment or altered mental status, or were otherwise unable to provide consent. Of 98 413 emergency department presentations during the study period, 7503 adolescents underwent testing.InterventionsPatients completed a computerized sexual health survey. During the universally offered screening intervention, gonorrhea and chlamydia screening was offered to all participants, and clinical decision support for testing was based solely on the patient's decision to undergo testing (survey results were not available to clinicians). During the targeted screening intervention, a validated risk score derived from the survey based on patient-reported behavioral data was integrated into the electronic health record to provide clinical decision support for gonorrhea and chlamydia testing. The usual care phase represented the period before the survey was integrated into emergency department care.Main Outcomes and MeasuresGonorrhea and chlamydia detection rates per 1000 eligible patients per 2-week intervals among usual care, targeted, and universally offered screening strategies.ResultsOf the 98 413 patient visits, 18 633 (19%) took place during the usual care phase, 41 082 (42%) during the targeted screening phase, and 38 698 (39%) during the universally offered screening phase. The study population was predominantly aged 16 to 18 years (n = 50 927 [51.7%]), with a mean (SD) age of 17.03 (1.42) years. A total of 57 013 participants (57.9%) were female. In the usual care phase, 1432 patients had testing ordered vs 3216 in the targeting screening phase and 2855 in the universal screening phase. Compared to usual care, population-level gonorrhea and chlamydia detection rates were higher during the targeted strategy phase (adjusted difference in infections detected per 1000 patient visits, 2.59; 95% CI, 2.46-2.73) and universally offered strategy phase (adjusted difference, 1.81; 95% CI, 1.67-1.94).Conclusions and RelevanceIn this comparative effectiveness trial, a targeted or universally offered screening tool in pediatric emergency departments was as","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008826","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":"Psychotropic Medications and Child Health.","authors":"Mark Olfson","doi":"10.1001/jamapediatrics.2025.3024","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3024","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015333","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":"Automated Insulin Delivery Systems and Glucose Management in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-Analysis.","authors":"Hannah Steiman de Visser,Seerat Waraich,Manik Chhabra,Jennifer Yamamoto,Ian Zenlea,Nicole Askin,Rasheda Rabbani,Jonathan McGavock, ","doi":"10.1001/jamapediatrics.2025.2740","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2740","url":null,"abstract":"ImportanceYouth living with type 1 diabetes (T1D) are increasingly choosing automated insulin delivery (AID) systems to manage their blood glucose. Few systematic reviews meta-analyzing results from randomized clinical trials (RCTs) are available to guide decision-making.ObjectiveTo study the association of prolonged AID system use in an outpatient setting with measures of glucose management and quality of life in youth with T1D.Data SourcesMEDLINE, Embase, CINAHL, and Cochrane Central were searched from January 2017 to March 2025 to identify eligible RCTs.Study SelectionTwo reviewers independently performed literature screening, data extraction, and quality assessment. Included in the analysis were RCTs of youth aged 6 to 18 years with T1D that assessed the efficacy of AID systems in outpatient settings longer than 48 hours compared with any other insulin regimen.Data Extraction and SynthesisTwo reviewers performed data extraction and quality assessment independently and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PRISMA literature search extension guidelines. Random-effects meta-analysis models were used to estimate the pooled measures of efficacy as a mean difference (MD) with 95% CIs for outcomes measures.Main Outcomes and MeasuresThe 2 primary outcome measures were time in range (TIR) and glycated hemoglobin (HbA1c).ResultsOf 2363 citations retrieved, 11 RCTs (n = 901 participants) with measures of HbA1c and 10 RCTs (n = 786 participants) with measures of TIR were included. RCTs tested interventions lasting a mean (SD) of 31 (26) weeks on youth with a median age of 12 years (range, 10.8-15.9 years); 51% were female, mean (SD) HbA1c level was 8.4% (1.1%), and mean (SD) TIR was 51% (9%). Random-effects models revealed that, compared with any insulin regimen, HbA1c level was reduced -0.41% (95% CI, -0.58% to -0.25%; I2 = 39%), whereas TIR increased 11.5% (95% CI, 9.3%-13.7%; I2 = 23%) with nighttime TIR increasing 19.7% (95% CI, 17.0%-22.4%; I2 = 36%). Random-effects models also revealed that AID use was associated with reduced time spent in hypoglycemia (<3.9 mml/L; MD = -0.32%; 95% CI, -0.60% to -0.03%; I2 = 18%) and hyperglycemia (>10 mmol/L; MD = -10.8%; 95% CI, -14.4% to -7.2%; I2 = 55%), particularly during the night (MD = -14.4%; 95% CI, -19.9% to -8.9%; I2 = 79%) compared with any insulin regimen. There were no differences in adverse events between study arms. Only 2 studies reported changes in QOL.Conclusions and RelevanceThis systematic review and meta-analysis found that compared with any other insulin regimen, use of AID systems by youth with T1D was associated with clinically meaningful improvements in multiple measures of glucose management, including the risk of both hyperglycemia and hypoglycemia, without increasing the risk of adverse events. More data are needed on the efficacy of AID systems on patient report outcomes.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"30 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008828","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":"Masked Pregnancy Risk in Gender-Diverse Adolescents.","authors":"Chun-Chieh Chen,Shiuan-Chih Chen","doi":"10.1001/jamapediatrics.2025.3002","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3002","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"13 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008834","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":"Lasting Burden of Preterm Birth on Health and Health Services.","authors":"Amaris M Keiser,Barbara Schmidt","doi":"10.1001/jamapediatrics.2025.3143","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3143","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"27 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008824","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":"Masked Pregnancy Risk in Gender-Diverse Adolescents-Reply.","authors":"Michele L Ybarra,Elizabeth M Saewyc,L Zachary DuBois","doi":"10.1001/jamapediatrics.2025.3005","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3005","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008827","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":"Preterm Birth and Risk of Health Service Use, Morbidity, and Medication Needs at 5 Years.","authors":"Lindsay L Richter,Ye Shen,Sarka Lisonkova,Jeffrey N Bone,Arianne Albert,Matthew S P Ho,Emily Kieran,Edmond S Chan,Cherry Mammen,Carol Lam,Anthony K C Chan,Ashley Roberts,Kristopher T Kang,Michael Castaldo,Dax Rumsey,Tara McGrath,Kevin C Harris,Connie L Yang,Jonathan Wong,Natalie H Chan,James Lee,Shahrad R Rassekh,Jennifer Hutcheon,Joseph Y Ting","doi":"10.1001/jamapediatrics.2025.2724","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.2724","url":null,"abstract":"ImportanceNeonatal intensive care has advanced over recent decades, yet premature birth remains associated with increased neonatal mortality and morbidity.ObjectiveTo describe health service use, morbidity, and medication needs up to age 5 years in a contemporary cohort of children born preterm.Design, Setting, and ParticipantsThis population-based cohort study was conducted in British Columbia (BC), Canada, using health service and pharmacy data linked using provincial administrative databases. Data for a sample of 465 338 children born at 22 to 44 weeks' gestational age (GA) in BC from April 2004 to December 2014 were available. After exclusions for missing information on GA or birth weight, incomplete linkage, or loss of registration, the cohort included 448 819 children (96.5%), with 420 309 (93.6%) having complete 5-year follow-up until 2019. Data were analyzed from May 2023 to April 2025.ExposuresGA at birth, grouped into 8 categories: 22 to 24, 25 to 27, 28 to 30, 31 to 33, 34 to 36, 37 to 38, 39 to 41 weeks (reference), and 42 to 44 weeks.Main Outcomes and MeasuresHealth service use (hospitalizations and outpatient visits), morbidity (combined inpatient and outpatient diagnoses), and medication needs (outpatient prescriptions).ResultsOf 448 819 children (mean [SD] age at follow-up, 4.8 [0.69]; 230 351 [51.3%] male), 42 080 (9.4%) were born before 37 weeks. Hospitalization rates within 5 years were higher for children born earlier compared to 39 to 41 weeks: 22 to 24 weeks (risk ratio [RR], 6.37; 95% CI, 5.62-7.22; risk difference [RD], 464.35 per 1000 patients; 95% CI, 395.62-533.08), 25 to 27 weeks (RR, 4.52; 95% CI, 4.15-4.92; RD, 304.21; 95% CI, 271.42-336.99), 28 to 30 weeks (RR, 2.70; 95% CI, 2.49-2.93; RD, 146.9; 95% CI, 128.01-165.78), 31 to 33 weeks (RR, 1.91; 95% CI, 1.81-2.03; RD, 79.08; 95% CI, 69.56-88.61), 34 to 36 weeks (RR, 1.53; 95% CI, 1.49-1.58; RD, 46.03; 95% CI, 42.13-49.92), and 37-38 weeks (RR, 1.16; 95% CI, 1.14-1.18; RD, 13.84; 95% CI, 11.9-15.78). Earlier GA was associated with increased outpatient visits by age 5 years. Children born preterm exhibited higher rates of respiratory (RR, 1.33; 95% CI, 1.30-1.37 to RR, 3.96; 95% CI, 3.30-4.70), endocrine (RR, 1.13; 95% CI, 1.09-1.18 to RR, 2.37; 95% CI, 1.65-3.27), gastrointestinal (RR, 1.26; 95% CI, 1.11-1.43 to RR, 6.36; 95% CI, 3.05-11.49), kidney (RR, 1.17; 95% CI, 1.08-1.26 to RR, 3.39; 95% CI, 1.86-5.59), neurodevelopmental (RR, 1.60; 95% CI, 1.55-1.66 to RR, 8.04; 95% CI, 6.78-9.44), and sleep (RR, 1.35; 95% CI, 1.21-1.51 to RR, 3.39; 95% CI, 1.34-6.87) disorders. Children born preterm were more likely to receive outpatient antibiotics, bronchodilators, corticosteroids, diuretics, and thyroid hormones.Conclusions and RelevanceIn this population-based cohort study, despite neonatal care advancements, children born preterm required more health care resources and faced greater health challenges in their first 5 years.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"24 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008820","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}