Pediatrics最新文献

{"title":"Extracorporeal Membrane Oxygenation and Eculizumab for Cardiac Failure in STEC-HUS.","authors":"Marissa Y Chou,Eesha Natarajan,Andrew J Connolly,Mauro Caffarelli,Duncan Henry,Loren D Sacks","doi":"10.1542/peds.2024-070247","DOIUrl":"https://doi.org/10.1542/peds.2024-070247","url":null,"abstract":"Hemolytic uremic syndrome (HUS) is a complication of Shiga toxin-producing Escherichia coli (STEC) infection that can cause acute renal failure and introduce serious extrarenal organ injury. The most life threatening of these include cardiac failure and thrombocytopenia. Here, we present a case of severe STEC-HUS in a previously healthy 2-year-old boy who progressed to cardiac failure necessitating extracorporeal membrane oxygenation (ECMO). Following ECMO cannulation, he was treated with eculizumab, an anticomplement component 5 monoclonal antibody. The patient required ECMO for 5 days and subsequently survived decannulation with normal cardiac function and a good neurological outcome. This case illustrates the feasibility of ECMO despite the consumptive thrombocytopenia characteristic of HUS as well as the potential role of eculizumab in facilitating cardiac recovery. Additionally, we propose anticoagulation parameters balancing HUS-related thrombocytopenia with hemorrhagic complications while on ECMO. Further studies are warranted to better understand complement dysregulation in the pathophysiology of STEC-HUS and develop treatment guidelines for STEC-HUS with cardiac manifestations.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296255","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":"Late Antibiotic Use Among Preterm Infants Admitted to the Neonatal Intensive Care Unit.","authors":"Sarah A Coggins,Alvaro Zevallos Barboza,Karen M Puopolo,Dustin D Flannery","doi":"10.1542/peds.2025-071372","DOIUrl":"https://doi.org/10.1542/peds.2025-071372","url":null,"abstract":"BACKGROUND AND OBJECTIVETo describe antibiotic use patterns in preterm infants aged over 3 days.METHODSThis was a retrospective cross-sectional cohort study using the Premier Health Database, including infants at or under 34 weeks' gestation who were admitted to a neonatal intensive care unit (NICU) from 2009 to 2023. Infants who were transferred, discharged, or who died before day 4 and antibiotic courses initiated on days 1 through 3 after birth were excluded. Late antibiotic regimens were defined by initiation on or after day 4 and categorized by the antibiotics prescribed on the first day of each course. Outcomes included the proportion of infants exposed to any late antibiotic, distribution of antibiotic regimens over the study period, and distribution of antibiotic regimens over the course of NICU hospitalization.RESULTSAmong 420 687 eligible infants admitted to 699 centers over 15 years, 65 398 infants (15.5%) were administered late antibiotics. Antibiotic administration was inversely correlated with gestational age, with 75.0% of infants born 22 to 24 weeks given late antibiotics. There were 1020 unique late antibiotic regimens identified: vancomycin and gentamicin (19.2%) and ampicillin and gentamicin (12.0%) were the most frequent late regimens. Between 2009 and 2023, use of nafcillin or oxacillin-containing regimens (7.3% to 17.8%) and use of piperacillin/tazobactam or cefepime-containing regimens (4.5% to 24.3%) increased, whereas the use of vancomycin-containing regimens decreased (58.8% to 36.0%). Antibiotic choice changed over the NICU care course, with cefazolin being the dominant exposure after 90 days of age.CONCLUSIONSSignificant heterogeneity in late antibiotic administration and content supports the need for late antibiotic stewardship guidance among preterm infants.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296256","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":"School Disengagement Among Children With Mental Health Conditions Pre- and Intra-COVID-19 Pandemic.","authors":"Fiorella B Castillo,Elisa Muñiz,Ellen J Silver,Blanche Benenson,Maria Valicenti-McDermott,Ruth E K Stein","doi":"10.1542/peds.2024-068387","DOIUrl":"https://doi.org/10.1542/peds.2024-068387","url":null,"abstract":"OBJECTIVESSchool disengagement (SD) is associated with mental health, educational, and behavioral challenges. This study explored temporal changes in SD and SD rates among children with mental health conditions (MHCs) in a representative sample of US children aged 6 to 17 years from 2018 to 2022 and identified SD correlates.METHODSWe analyzed cross-sectional National Survey of Children's Health (NSCH) data from 2018 and 2019 (pre-pandemic), 2020 (lockdown), and 2021 and 2022 (intra-pandemic) (N = 136 576). We defined SD using an NSCH-developed measure based on parent responses regarding caring about school and completing homework. MHCs included anxiety, depression, behavioral/conduct problems, or attention-deficit/hyperactivity disorder. We adjusted for complex sampling and calculated weighted prevalence estimates for all variables and assessed for monotonic trends. χ2 and logistic regression assessed the relationships among SD, year, and MHCs, controlling for covariates.RESULTSThe 5-year cohort was composed of 51.1% boys, 51% 12- to 17-year-old children, 11.1% children who had a special education plan (SEP), 5.2% children who had missed at least 11 school days, and 6.1% children who had repeated a grade. SD rates were higher during pandemic years compared with 2018 (P < .001), especially for children with MHCs. Higher SD odds were seen in 2020, 2021, and 2022 compared with 2018 (2020, adjusted odds ratio [aOR]: 1.30, 99% CI: 1.1-1.54; 2021, aOR: 1.27, 99% CI: 1.08-1.49; 2022, aOR: 1.28, 99% CI: 1.1-1.49); no differences were observed between 2018 and 2019. Children with MHCs, overall health status that was very good or lower, food insecurity, a total of 4 or more lifetime moves, an SEP, and incidence of repeating a grade had higher SD odds.CONCLUSIONSSD rates have been higher since 2020 for children with MHCs and remain above pre-pandemic levels. MHCs and social and educational factors influence SD odds. These findings have implications for identifying children who are at risk for SD, particularly those with MHCs.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"102 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288281","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":"Transparent Reporting of Pediatric Clinical Trial Interventions: TIDieR-Children and Adolescents.","authors":"Katherine Goren,Veronica Ka Wai Lai,Ami Baba,Maureen Smith,Karel Allegaert,Nancy J Butcher,Ricardo Fernandes,Peter J Gill,Lisa Hartling,Edmund Juszczak,Patricia E Longmuir,Colin Macarthur,Kayur Mehta,David Metz,Kim An Nguyen,Michal Odermarsky,Ramesh Poluru,Diane Purper-Ouakil,Giorgio Reggiardo,Catherine Stratton,Peter Szatmari,Amit Trivedi,Julia Upton,Tammy Hoffmann,Martin Offringa","doi":"10.1542/peds.2025-072867","DOIUrl":"https://doi.org/10.1542/peds.2025-072867","url":null,"abstract":"Pediatric randomized controlled trials (RCTs) inform decisions concerning the choice of interventions in children and adolescents. To enable the implementation of effective interventions, RCT reports need to provide adequate details on the elements, infrastructure, and delivery of these interventions. Using the 12-item Template for the Intervention Description and Replication (TIDieR) framework, an international team developed guidance for comprehensive reporting of trial interventions in pediatric RCT protocols and reports. We (1) identified initial pediatric considerations (PCs) and examples of good reporting using 50 recent pediatric RCT reports, (2) held an expert panel meeting, (3) conducted a Family Caregiver Workshop to discuss and get input on PCs, (4) compiled PCs and examples of good reporting, and (5) achieved consensus on final PCs and examples. Thirteen PCs reached consensus; they address how trial intervention materials were appropriate for the age and developmental stage of trial participants, which adjustments to enhance palatability of medications and acceptability of interventions were implemented, and how pediatric-specific dosing was determined. Consensus was also reached on accompanying good reporting exemplars. Presenting a minimum set of considerations pertinent to pediatric trial interventions, the TIDieR-Child & Adolescent Health (TIDieR-C) checklist can help trial authors and evidence end users comprehensively report and appraise tested interventions. It can be used with the pediatric-specific extensions of the Standard Protocol Items for Randomized Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT): SPIRIT-Children & Adolescents and CONSORT-Children & Adolescents. Uptake of this guidance may lead to improved understanding, replicability, and implementation fidelity of effective trial interventions.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288329","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":"Prognostic Accuracy of BPD Definitions for Long-Term Outcomes in Preterm Infants: A Systematic Review.","authors":"Trixie A Katz,Rosemarie de Ridder,Eduardo Bancalari,Rosemary D Higgins,Tetsuya Isayama,Erik A Jensen,Martin Offringa,J Jane Pillow,Prakesh S Shah,Roger F Soll,Benjamin Stoecklin,Joost G Daams,Anton H van Kaam,Wes Onland,Suzanne M Mugie","doi":"10.1542/peds.2025-070741","DOIUrl":"https://doi.org/10.1542/peds.2025-070741","url":null,"abstract":"BACKGROUND AND OBJECTIVESSince the first description of bronchopulmonary dysplasia (BPD), multiple definitions to diagnose BPD and its grading have been published. Several studies have compared the predictive performance of these definitions for long-term outcomes. The objective was to identify the BPD definition with the optimal predictive performance for long-term respiratory and neurological outcomes in preterm infants.METHODSAn electronic search identified studies in Medline and Embase from inception to August 2024. Studies assessing the performance of one or more BPD definitions for predicting long-term respiratory and/or neurological outcomes were included. We used the Quality in Prognostic Studies (QUIPS) tool for bias assessment. Reported prognostic accuracy of 5 BPD definitions (the 1988 Shennan, the 2001 National Institutes of Health [NIH], the 2017 Canadian Neonatal Network, the 2018 NIH, and the 2019 Neonatal Research Network definition) was tabulated using specificity, sensitivity, C statistic, risk, or odds ratio.RESULTSOf the 6045 identified studies, 18 were included. Heterogeneity between studies resulted in inconsistent prognostic accuracy for long-term outcomes. The 2001 NIH definition showed higher prognostic accuracy for respiratory and neurological outcomes compared with the 1988 Shennan BPD definition. Only 5 studies showed a low to moderate risk of bias, and a sensitivity analysis confirmed the results. The limitations included challenges in comparing studies due to population heterogeneity and outcome definitions.CONCLUSIONSThis systematic review shows that comparisons between the 2001 NIH definition and newer BPD definitions yield inconsistent results for predicting long-term outcomes. None of the current BPD definitions consistently provided sufficient prognostic accuracy for long-term respiratory and neurodevelopmental sequelae in very preterm infants.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"213 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283695","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 Complex Challenge of Defining Bronchopulmonary Dysplasia.","authors":"Samia Aleem,Rachel G Greenberg","doi":"10.1542/peds.2025-073156","DOIUrl":"https://doi.org/10.1542/peds.2025-073156","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"51 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283525","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":"Interactive Virtual Presence to Remotely Assist Parents With Car Seat Installation.","authors":"David C Schwebel,Morag MacKay,T Mark Beasley,Anna Johnston,Kristen Beckworth,Abby Beerman,Mikayla Harris,Elizabeth Koldoff,Sanny Rivera,Janice Williams","doi":"10.1542/peds.2025-071867","DOIUrl":"https://doi.org/10.1542/peds.2025-071867","url":null,"abstract":"OBJECTIVESMotor vehicle crashes are a leading cause of preventable pediatric death. Child restraints (car seats) reduce risk, but ∼80% are installed and/or used incorrectly. Individualized appointments with certified child passenger safety technicians improve installation and usage, but access is inadequate.METHODSA phase III randomized noninferiority clinical trial was conducted from 2020 to 2023 at 7 US locations with 1509 individuals who regularly drove vehicles with child restraints installed (booster seats excluded). Participants were randomly assigned to install a child restraint with assistance from a certified technician either live and on-site or remotely via interactive virtual presence, a smartphone app offering simultaneous verbal and visual communication plus the ability to interact virtually, telestrate, and freeze screens. The accuracy of restraint installation/usage was scored objectively.RESULTSMixed model analyses were conducted with technicians nested in the research site as a random effect, and with technician, site, and child restraint installation type as covariates. The on-site group had an unadjusted mean of 97.7% (SD = 3.5) of installation/usage facets correct following the intervention, and the remote group had an unadjusted mean of 95.6% (SD = 5.8). The adjusted difference of 1.80 fell within the a priori noninferiority margin of 2.5% (upper bound = 2.34; P = .006). Sensitivity analyses controlling for demographics, how the restraint was previously installed, and installation type yielded comparable findings.CONCLUSIONSThe accuracy of restraint installation and usage following education with a remotely located technician via interactive virtual presence was not inferior to accuracy with an on-site technician. Uptake by industry, nonprofit, or government agencies could dramatically improve pediatric public health, especially among underserved populations.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"122 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277357","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":"E-Cigarettes and the Nicotine Epidemic: Statement From the International Pediatric Association.","authors":"Monika Arora,Muralidhar M Kulkarni,Shishirendu Ghosal,Aishwarya Sathyan,Mansi Gupta,Simran Verma,Mychelle Farmer,Adamos Hadjipanayis,Jonathan D Klein,Jonathan Winickoff,Naveen Thacker,Stanton A Glantz","doi":"10.1542/peds.2025-072337","DOIUrl":"https://doi.org/10.1542/peds.2025-072337","url":null,"abstract":"Electronic cigarettes (e-cigarettes) have rapidly emerged as a new frontier in the global nicotine epidemic, particularly targeting children, adolescents, and youth. Marketed as safer alternatives and cessation aids, e-cigarettes deliver highly addictive nicotine, often via protonated formulations that enhance absorption and dependency. This position paper by the International Pediatric Association (IPA) synthesizes global evidence on the use, risks, and regulatory gaps of e-cigarettes. It highlights increasing prevalence among youth, driven by misleading marketing, ease of access (especially via social media), appealing flavors, and stealth designs. E-cigarettes have not proven significantly effective through real-world studies for smoking cessation in youth or adults when used as consumer products. Instead, dual use (using e-cigarettes and cigarettes at the same time) and long-term nicotine dependence are common. E-cigarette use is associated with cardiovascular, metabolic, respiratory, oral diseases and cancer, with dual users facing greater health risks than cigarette smokers alone. Drawing on global data and recommendations from apex public health organizations, IPA calls for comprehensive bans or stringent regulation on the manufacture, marketing, sale, and use of e-cigarettes. Pediatricians and medical associations play a vital role in advocating, educating, and providing clinical support to combat industry-driven misinformation and safeguard the youth. IPA urges its member societies to adopt unified, evidence-based policies to restrict access and exposure and to ensure governments are guided by robust scientific evidence-not industry interests. E-cigarettes threaten to reverse decades of progress in tobacco control-an urgent, coordinated action is required to safeguard the health of future generations.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"113 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254587","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 Management of Bronchiolitis Across a Primary Care Network.","authors":"Andrea V Rivera-Sepulveda,Cara F Harwell,Courtney E Nelson,John Sarandria,Thomas A Lacy,Jonathan M Miller,Preethi Kumar,Collin R Miller,Arezoo Zomorrodi, ","doi":"10.1542/peds.2024-068136","DOIUrl":"https://doi.org/10.1542/peds.2024-068136","url":null,"abstract":"BACKGROUND AND OBJECTIVEBronchiolitis is the most common respiratory illness in children younger than 2 years. Although pharmacotherapy has not been shown to alter mild disease course, overuse continues in the primary care setting. We sought to improve the management of bronchiolitis in a large primary care network by reducing bronchodilator use from 24% to 15% while maintaining steroid use at 7% within 12 months.METHODSOur primary care network is composed of 39 clinics in rural and urban settings across 3 states. Interventions through 4 Plan-Do-Study-Act cycles included (1) stakeholder engagement, education, and implementation of a clinical algorithm with supportive electronic health record enhancements, (2) data sharing and feedback, (3) refinement of documentation, and (4) incentives and automated individual feedback. The outcome measure was bronchodilator and steroid use. The process measure was respiratory score (RS) documentation. The balancing measure was the percentage of return visits within 7 days of the initial primary care visit.RESULTSWe included 3158 patients in the baseline and 5465 in the postintervention period. Albuterol use decreased from 24% to 11%. Steroid use decreased from 7% to 1%. The RS documentation did not improve and was not continued. Return visits decreased from 10% to 8%.CONCLUSIONData transparency, provider scorecards, and standardization of care effectively promoted compliance and improvement through a learning health system within a large primary care network. Primary care's involvement in this quality initiative to improve children's outcomes was key to its success.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"34 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246566","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":"Smoothing the Path Between Primary Care and Developmental Services for At-Risk Children.","authors":"Christopher J Stille","doi":"10.1542/peds.2025-072367","DOIUrl":"https://doi.org/10.1542/peds.2025-072367","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"80 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241026","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}