Pediatrics最新文献

{"title":"Global Occurrence of Infant Botulism: 2007-2021.","authors":"Haydee A Dabritz, Connie H Chung, Jennifer S Read, Jessica M Khouri","doi":"10.1542/peds.2024-068791","DOIUrl":"https://doi.org/10.1542/peds.2024-068791","url":null,"abstract":"<p><p>We sought to summarize the worldwide occurrence and epidemiology of infant botulism (IB) from 2007 to 2021. Data were collected through active and passive surveillance, via hospital inquiries to the Infant Botulism Treatment and Prevention Program regarding Human Botulism Immune Globulin Intravenous for patients with suspected IB, by contact with epidemiologists in countries with historically high case counts and by searching the medical literature. A case was defined as an infant with laboratory-confirmed botulism that was not due to ingestion of food containing botulinum toxin. Eighteen countries reported their first cases between 2007 and 2021. Of the 2943 cases recognized from 2007 to 2021, 1587 were type A, 6 type Ab or A&B, 1 type Af, 1254 type B, 9 type Ba, 26 type Bf, 1 type Bh, 8 type E, 15 type F, and 36 of unknown toxin type. Median age at onset was 16.8 weeks and 48.4% of patients were female. Patients in the rest of the world (ROW) were more likely to be intubated than US patients (50.3% ROW vs 21.2%), have longer hospital stays (median 27.0 days ROW vs 12.0 days), and have consumed honey (19.7% ROW vs 3.8%). In conclusion, the distribution of IB cases worldwide does not reflect the detection of Clostridium botulinum spores in soil, suggesting IB is underrecognized in certain countries. To improve recognition of IB, physicians should consider IB when an infant presents with cranial nerve palsies, hypotonia, constipation, and/or poor feeding. Pediatricians globally should continue to educate parents about honey ingestion as one risk factor for IB.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and Completion of Select Routine Childhood Vaccinations.","authors":"Malini B DeSilva, Jacob Haapala, Gabriela Vazquez-Benitez, Matthew F Daley, Bruno Lewin, Nicola P Klein, Elizabeth G Liles, Lisa A Jackson, Joshua T B Williams, James G Donahue, W Katherine Yih, Elyse O Kharbanda","doi":"10.1542/peds.2024-068244","DOIUrl":"https://doi.org/10.1542/peds.2024-068244","url":null,"abstract":"<p><p></p><p><strong>Objectives: </strong>To evaluate rotavirus (RV), diphtheria, tetanus, and acellular pertussis (DTaP), and pneumococcal conjugate vaccine (PCV) vaccine coverage and factors associated with vaccine uptake from 2018 through 2023.</p><p><strong>Methods: </strong>We included infants born between January 1, 2018 and May 31, 2023, with a minimum of 9 months of enrollment in the first 12 months of life and at least 1 medical visit between 9 and 12 months at 1 of 8 Vaccine Safety Datalink health systems. We evaluated coverage with 2 doses of RV, DTaP, and PCV vaccines at 5 months and completion of recommended doses by 12 months. We evaluated associations of patient race, ethnicity, caregiver's primary language, Medicaid, and time period with vaccine uptake.</p><p><strong>Results: </strong>We included 395 143 infants: 48.4% female; 14.7% non-Hispanic Asian; 5.8% non-Hispanic Black; 34.2% Hispanic; and 20.6% with Medicaid. Coverage for 2 doses of all 3 vaccines at 5 months was 87.8% (95% CI 86.9-88.7) in February 2020 vs 80.8% (95% CI 79.8-81.8) in October 2023. Vaccine series completion at 12 months was highest in January 2020 with 92.3% (95% CI 91.6-92.9) vs 89.6% (95% CI 88.8-90.3) in October 2023. Factors associated with lower vaccine uptake included having a caregiver whose primary language was not English or Spanish, non-Hispanic Black race, and Medicaid.</p><p><strong>Conclusion: </strong>Over 3 years after the COVID-19 pandemic started, coverage for selected routine childhood immunizations remained below prepandemic levels. Demographic factors, which may reflect structural barriers to accessing care, likely affected coverage. Focused interventions are needed to improve vaccine coverage in all populations.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Management of the First Hour of Premature Infants: A Meta-Analysis.","authors":"Sophie Tribolet, Sarah Dénes, Vincent Rigo","doi":"10.1542/peds.2024-068606","DOIUrl":"https://doi.org/10.1542/peds.2024-068606","url":null,"abstract":"<p><strong>Context: </strong>The postnatal management of preterm infants at birth may influence their clinical course in the short, medium, and long term. The concept of the \"Golden Hour\" (GH) has emerged in neonatology, aiming to standardize this management.</p><p><strong>Objective: </strong>We conducted a meta-analysis to assess GH's impact on early clinical outcomes and on the comorbidities of prematurity.</p><p><strong>Data sources: </strong>Pubmed, Embase, Scopus, and Cochrane Library were searched without any restriction.</p><p><strong>Study selection: </strong>We included randomized, prospective, and retrospective studies comparing periods with and without the application of a GH protocol for preterm birth.</p><p><strong>Data extraction: </strong>Two independent reviewers screened titles and abstracts and assessed full texts for eligibility.</p><p><strong>Results: </strong>Twelve prospective and 6 retrospective studies were included, for a total of 5104 patients. There was a significant reduction in hypothermia both on admission and at 1 hour (odds ratio [OR], 0.40 [95% CI, 0.27-0.60] and OR 0.39 [95% CI, 0.18-0.85]), with increased temperature (mean difference [MD], +0.57 °C [95% CI, 0.07-1.07]). Mean blood glucose and hypoglycemia rates on admission were not statistically affected. However, time to intravenous infusion was reduced (MD, -27.51 minutes [95% CI, -49.40 to -5.56]). There was a significantly lower rate of severe intraventricular hemorrhage (OR, 0.65 [95% CI, 0.47-0.89]) and a trend toward decreased bronchopulmonary dysplasia (OR, 0.69 [95% CI, 0.47-1.02]). Time to administration of surfactant was statistically reduced (MD, -23.6 minutes [95% CI, -42.2 to -5]). Mortality and other comorbidities of prematurity were not different.</p><p><strong>Limitations: </strong>Four studies were judged to be of poor quality, and certainty for evidence was graded as low or very low.</p><p><strong>Conclusions: </strong>The application of a GH at birth reduced the rate of hypothermia and the time required for intravenous infusion without statistically significant impact on glycemic control.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Now What? Making the Most of the Child Opportunity Index.","authors":"Michael D Warren, Morgan F McDonald","doi":"10.1542/peds.2024-069739","DOIUrl":"https://doi.org/10.1542/peds.2024-069739","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Child Opportunity Index and Children's Health: A Meta-Analysis.","authors":"Jordan Tyris, Diane L Putnick, Susan Keller, Kavita Parikh, Edwina H Yeung","doi":"10.1542/peds.2024-067873","DOIUrl":"https://doi.org/10.1542/peds.2024-067873","url":null,"abstract":"<p><p></p><p><strong>Context: </strong>Quantifying the impact of place on pediatric health is difficult given the diverse methodologies used to measure place-based social determinants. However, the Child Opportunity Index (COI) is increasingly used to study these relationships.</p><p><strong>Objective: </strong>To synthesize associations between the COI and pediatric health.</p><p><strong>Data sources: </strong>Fifteen databases, 4 gray literature sources, and diversitydatakids.org searched from 2014 to 2024.</p><p><strong>Study selection: </strong>US-based observational studies that evaluated children, the COI, and at least 1 pediatric health outcome.</p><p><strong>Data extraction: </strong>Protocol registered with PROSPERO (CRD42023418407). Random-effects models created pooled odds ratios (ORs) comparing very low/low COI to high/very high COI for mortality, emergency department (ED) use, and hospital use. Clinically relevant subgroups were explored.</p><p><strong>Results: </strong>Most studies (n = 61 of 85; 72%) reported inverse associations between the COI and an adverse outcome. Lower COI was associated with higher odds of mortality (OR, 1.50; 95% CI, 1.31-1.94; tau squared [τ2] = 0.045; 15 associations from 13 studies). Overall, ED visits were similar (OR, 1.38; 95% CI, 0.97-1.95; τ2 = 0.312; 10 associations from 6 studies), but the subgroup of all-cause ED visits were significantly higher among children with lower COI (OR, 1.66; 95% CI, 1.19-2.31; τ2 = 0.198; 7 associations from 5 studies). Select hospitalization subgroups (medical, surgical/trauma, and >30-day rehospitalizations) were significantly associated with COI, but not overall hospitalizations (OR, 1.15; 95% CI, 0.96-1.36; τ2 = 0.090; 12 studies).</p><p><strong>Limitations: </strong>Meta-analyses were unadjusted.</p><p><strong>Conclusions: </strong>Place is a risk factor for children's mortality and select measures of health care use. Shifting the focus from identifying place-based disparities to cocreating community-engaged strategies that mitigate disparities may effectively advance children's health equity.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urine Dipstick for the Diagnosis of Urinary Tract Infection in Febrile Infants Aged 2 to 6 Months.","authors":"Kathryn M Hunt, Rebecca S Green, Laura F Sartori, Paul L Aronson, James M Chamberlain, Todd A Florin, Kenneth A Michelson, Michael C Monuteaux, Pradip P Chaudhari, Lise E Nigrovic","doi":"10.1542/peds.2024-068671","DOIUrl":"https://doi.org/10.1542/peds.2024-068671","url":null,"abstract":"<p><strong>Objective: </strong>Urine dipsticks can be performed at the point of care, whereas urinalysis requires laboratory analysis. We compared the accuracy of urine dipstick with urinalysis for the diagnosis of urinary tract infection (UTI) in febrile infants aged 2 to 6 months.</p><p><strong>Methods: </strong>We performed a cross-sectional study of previously healthy infants aged 2 to 6 months who presented to one of 5 emergency departments with a temperature greater than or equal to 38.0 °C and had a catheterized urine culture obtained. We defined a UTI with a urine culture growing greater than or equal to 50 000 colony-forming units (CFUs) per milliliter of a single bacterial uropathogen. Using receiver operator characteristic (ROC) curve analysis to select the optimal urine white blood cell (WBC) cut point, we compared positive urine dipstick (≥1+ leukocyte esterase or positive nitrite) to dichotomized urine WBC count for the diagnosis of UTI.</p><p><strong>Results: </strong>Of 9387 febrile infants who had a urine culture performed, 1044 (11%) had a UTI. Escherichia coli was the most common pathogen identified (923; 88.4%). The optimal urine WBC cut point was greater than or equal to 7 cells per high-power field (HPF). When compared with urine WBC count of greater than or equal to 7 cells per HPF, urine dipstick had a higher sensitivity (831/921 [90.2%] dipstick vs 738/880 [83.9%] urine WBC; difference 6.4%, 95% CI 3.8%-8.9%) and specificity (6352/6862 [92.6%] dipstick vs 3679/4231 [87.0%] urine WBC; difference 5.6%, 95% CI 4.7%-6.6%).</p><p><strong>Conclusion: </strong>Urine dipstick is an accurate diagnostic test for UTI in febrile infants aged 2 to 6 months. Laboratory urinalysis may not be required to guide initial treatment decisions.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orchestrating a Successful Veto Campaign Against a Detrimental School Immunization Bill.","authors":"Beth Bloom Emrick, Elizabeth A Copenhaver, Jennifer Gerlach, Jamie L Jeffrey, Andrea M Lauffer, Kathleen Martin, Youmna Mousattat, Lisa M Costello","doi":"10.1542/peds.2024-068983","DOIUrl":"https://doi.org/10.1542/peds.2024-068983","url":null,"abstract":"<p><p>West Virginia has one of the most robust childhood school-entry immunization policies in the nation, allowing only medical exemptions. As of the 2024 state legislative session, the last reported case of measles in West Virginia was in 2009. For over a decade, multiple bills have been introduced to attempt to weaken the immunization policy. In 2024, the West Virginia Legislature passed House Bill (HB) 5105, which would allow private and parochial schools in West Virginia the option to opt out of state immunization requirements. This bill would threaten the well-being and lives of West Virginians by weakening herd immunity. In response, the West Virginia chapter of the American Academy of Pediatrics banded together with multiple stakeholders to coordinate a veto campaign for HB 5105 using media, petitions, phone calls, and in-person visits. Governor Jim Justice ultimately vetoed HB 5105. This case study highlights the importance of effective collaboration with stakeholders, engagement of medical organizations with shared goals, coordinated advocacy by health care professionals, and creating and implementing an effective public health message to maintain effective public health policy.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monoclonal antibody targeting IFNβ for the treatment of NXP2-positive ulcerative juvenile dermatomyositis.","authors":"Justina Guirguis, Vignesh Ramachandran, Ruth Ann Vleugels, Steven A Greenberg, Hanna Kim, Philip J Kahn, Vikash Oza","doi":"10.1542/peds.2024-067481","DOIUrl":"https://doi.org/10.1542/peds.2024-067481","url":null,"abstract":"<p><p>This report outlines the case of a 9-year-old girl with severe anti-nuclear matrix protein 2 antibody-positive juvenile dermatomyositis presenting with disease refractory to multiple traditional therapies. Treatment with an experimental monoclonal antibody inhibiting interferon beta (IFNβ) resulted in the rapid resolution of her muscle weakness and cutaneous and gastrointestinal ulcers. This case highlights the potential benefit of inhibiting IFNβ in the management of recalcitrant juvenile dermatomyositis.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care and Victim Services Use After Adolescent Violent Injuries, 1993-2023.","authors":"Keith L Hullenaar, Frederick P Rivara","doi":"10.1542/peds.2024-068284","DOIUrl":"https://doi.org/10.1542/peds.2024-068284","url":null,"abstract":"<p><p></p><p><strong>Background and objectives: </strong>Nonfatal assault injuries have significant consequences for adolescent health, but trends in health care use after such injuries are poorly understood. We analyzed locations of medical care, examined temporal trends in health care and victim service use, and explored variations by injury type among adolescent violent injuries.</p><p><strong>Methods: </strong>We analyzed the National Crime Victimization Survey (1994-2023) for injuries requiring care among adolescents aged 12 to 18 years. We estimated victimization rates and proportions of injuries receiving types of care using direct variance estimation. To identify trends in health care and victim service use, we used survey-weighted logistic regression models with year as an interval variable and specifications for quadratic relationships.</p><p><strong>Results: </strong>Among adolescent violent injuries receiving any treatment, 44.0% (95% CI, 39.9-48.2) were treated at a hospital or clinic. From 1996 to 2021 (5-year moving averages), rates of violent injuries receiving treatment declined by 84.0%, from 14.4 (12.4-16.4) to 2.3 (1.4-3.2) per 1000 adolescents. The percentage of injuries receiving hospital or clinic care increased from 36.9% in 1996 to 59.1% in 2009 (odds ratio [OR]year = 1.119, 95% CI 1.046-1.197), then decreased to 36.1% by 2021 (ORyear2 = 0.996, 95% CI 0.993-0.999). Victim service use remained consistently lower (ORyear = 0.991, 95% CI 0.955-1.027) and fluctuated between 14.1% and 22.9%.</p><p><strong>Conclusion: </strong>Adolescent violent injury rates significantly declined from 1994 to 2023. However, substantial proportions of injured adolescents receiving any type of care do not receive hospital-based care or victim services. Innovative approaches are needed to engage adolescent victims of violence in medical settings and improve access to support services.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Preteen Lipid Screening Rates at Well-Child Visits Through Quality Improvement Methods.","authors":"Ruth E Gardner, Katherine E Shedlock, Benjamin N Fogel","doi":"10.1542/peds.2024-066542","DOIUrl":"https://doi.org/10.1542/peds.2024-066542","url":null,"abstract":"<p><strong>Background: </strong>Universal lipid screening is recommended for all pediatric patients aged 9 to 11 years based on 2011 guidelines; however, current screening rates remain low. Our aim was to increase universal lipid screening rates in patients aged 9 to 11 years at our pediatric primary care practices from 5% to 50%.</p><p><strong>Methods: </strong>Baseline screening rates were obtained from May 2019 to April 2021. Provider education and electronic medical record (EMR) clinical decision support (CDS) were introduced in May 2021. Point-of-care (POC) testing was implemented at 1 site in May 2021 and 2 additional sites in May 2022. Provider feedback was performed at 1 site in February 2022, followed by ongoing quarterly provider feedback for all 3 sites in July 2022. Data were collected through April 2023. Rates were plotted on monthly statistical process control charts. Lipid results were analyzed to determine the number of abnormal test results and compared before and after POC testing introduction using χ2 tests.</p><p><strong>Results: </strong>Baseline testing rates ranged from 1% to 10%, which increased to 18% to 60% at completion of the study period. POC testing and provider feedback were the interventions with the most significant impact, whereas education and EMR CDS alone did not lead to a meaningful increase in screening rates. The proportion of eligible visits with abnormal lipids identified increased from 1.3% to 4.2% after introduction of POC testing.</p><p><strong>Conclusion: </strong>POC testing and provider feedback are effective strategies to improve universal lipid screening rates and increase the identification of children with abnormal lipids.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}