Pediatrics最新文献

Variability of Clinician Recommendations for Oseltamivir in Children Hospitalized With Influenza.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-25 DOI: 10.1542/peds.2024-069111

Hannah K Bassett,Suchitra Rao,Jimmy Beck,Patrick W Brady,Ravi Jhaveri,Torsten Joerger,Danni Liang,Ricardo Quinonez,Alaina Shine,Joanna Malec,Brian P Lucas,Alan R Schroeder

{"title":"Variability of Clinician Recommendations for Oseltamivir in Children Hospitalized With Influenza.","authors":"Hannah K Bassett,Suchitra Rao,Jimmy Beck,Patrick W Brady,Ravi Jhaveri,Torsten Joerger,Danni Liang,Ricardo Quinonez,Alaina Shine,Joanna Malec,Brian P Lucas,Alan R Schroeder","doi":"10.1542/peds.2024-069111","DOIUrl":"https://doi.org/10.1542/peds.2024-069111","url":null,"abstract":"BACKGROUND AND OBJECTIVESAlthough national recommendations advise antivirals for all hospitalized children with influenza, this recommendation is not supported by high-quality evidence like a randomized clinical trial, and recent data suggest nonadherence to guidelines. Our objective was to describe clinician treatment preferences for oseltamivir in hospitalized children.METHODSThis cross-sectional survey of pediatricians from 5 specialties was conducted at 7 US children's hospitals from March to June 2024. Four clinical vignettes meeting 2023 American Academy of Pediatrics (AAP) criteria for antiviral treatment were included. Our primary outcome was the average proportion of vignettes for which respondents recommended oseltamivir.RESULTSOf 1841 invited participants, 787 (42.7%) completed surveys. Participants were likely to recommend oseltamivir for 49.5% (95% CI, 47.0%-51.9%) of cases; this varied by site from 43.5% to 64.2% and by specialty from 41.6% (hospital medicine) to 70.9% (infectious disease). Longer duration of symptoms and less oxygen support significantly decreased the likelihood of recommending oseltamivir. Awareness of AAP recommendations increased the likelihood of recommending treatment, although aware respondents did not recommend treatment in 38% of cases. Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important.CONCLUSIONSOur results demonstrate nonadherence to national recommendations and variability in oseltamivir treatment for children hospitalized with influenza, indicating uncertainty and disagreement regarding which patients benefit from antivirals. A randomized controlled trial of oseltamivir in hospitalized children is needed to help strengthen current influenza treatment recommendations and inform clinicians of treatment benefit in specific pediatric populations.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876447","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}

引用次数: 0

Safety of LAIV Vaccination in Asthma or Wheeze: A Systematic Review and GRADE Assessment.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-24 DOI: 10.1542/peds.2024-068459

Allyn Bandell,Lucia Giles,Penélope Cervelo Bouzo,Gillian C Sibbring,Jon Maniaci,Henry Wojtczak,Andrew G Sokolow

{"title":"Safety of LAIV Vaccination in Asthma or Wheeze: A Systematic Review and GRADE Assessment.","authors":"Allyn Bandell,Lucia Giles,Penélope Cervelo Bouzo,Gillian C Sibbring,Jon Maniaci,Henry Wojtczak,Andrew G Sokolow","doi":"10.1542/peds.2024-068459","DOIUrl":"https://doi.org/10.1542/peds.2024-068459","url":null,"abstract":"CONTEXTThe US Advisory Committee on Immunization Practices states a contraindication for live attenuated influenza vaccine (LAIV) use in children aged 2 to 4 years with asthma or recurrent wheeze plus a precaution, defined as defer vaccine use, in those aged >5 years with asthma.OBJECTIVEWe assessed the certainty of evidence on the safety of LAIV vs inactivated influenza vaccine (IIV) or no vaccine, or before vs after LAIV, in eligible individuals with asthma and/or wheeze.DATA SOURCESEmbase, MEDLINE, CCTR, and CDSR were searched for eligible studies (database inception to August 27, 2024) via Ovid/Elsevier.STUDY SELECTIONScreening (title/abstract and full text) and data extraction were performed by a single reviewer; an independent reviewer screened 10%. Risk of bias (ROB) was assessed using ROB2 and ROBINS-I. Evidence certainty was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.RESULTSSearches yielded 24 eligible studies (28 publications); 15 comparative studies were included in the GRADE assessment. No difference in patient-reported safety outcomes was reported in 86.7% of studies comparing LAIV and IIV (all ages and disease severities; \"very low\" to \"moderate\" certainty evidence). A higher instance of rhinitis and a lower incidence of inpatient/emergency department visits and wheezing were reported after LAIV vs IIV. Evidence was mostly downgraded for ROB, imprecision, and indirectness. Similar results were observed for all comparisons.LIMITATIONSThe heterogeneity of identified outcomes precluded a meta-analysis.CONCLUSIONSThis suggests comparable safety outcomes with LAIV vs IIV in persons with asthma and/or recurrent wheeze, irrespective of disease severity.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"8 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872084","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}

引用次数: 0

LAIV Use for Children With Asthma or Recurrent Wheeze: Time to Move the Needle?

IF 8 2区医学

Pediatrics Pub Date : 2025-04-24 DOI: 10.1542/peds.2024-070120

Annika M Hofstetter,Melissa S Stockwell,Kristina A Bryant

引用次数: 0

USAID's Role in Saving Children's Lives: Past Legacy and Future Directions.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-24 DOI: 10.1542/peds.2025-071260

Alexandra L Coria,Brian Wahl,Naveen Thacker,Rachel Vreeman,Liesl Zühlke

引用次数: 0

Hypothermia and Adverse Outcomes in Very Preterm Infants: A Systematic Review.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-23 DOI: 10.1542/peds.2024-069668

Marije Hogeveen,Lotty Hooft,Wes Onland

{"title":"Hypothermia and Adverse Outcomes in Very Preterm Infants: A Systematic Review.","authors":"Marije Hogeveen,Lotty Hooft,Wes Onland","doi":"10.1542/peds.2024-069668","DOIUrl":"https://doi.org/10.1542/peds.2024-069668","url":null,"abstract":"CONTEXTHypothermia after very preterm birth, typically defined as a temperature less than 36 °C, is variably linked to neonatal mortality and morbidities.OBJECTIVETo examine the association between admission hypothermia and adverse outcomes in very preterm infants with a gestational age (GA) of less than 32 weeks.DATA SOURCESCENTRAL, MEDLINE, and Embase from inception to February 18, 2024.STUDY SELECTIONObservational or randomized designs reporting on the association between admission temperature and adverse outcomes in very preterm infants.DATA EXTRACTIONTwo reviewers screened abstracts and full texts, extracted the data, and assessed the risk of bias, following Meta-analysis Of Observational Studies in Epidemiology /Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We planned to perform random-effects meta-analyses, subgroup (GA, birthweight [BW], and income), sensitivity analysis (NOS, study type), and meta-regression (GA, BW). Outcomes included mortality and neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy (ROP), and sepsis.RESULTSThis review included 32 studies with >300 000 infants. The mean hypothermia rate was 42% (range 14%-88%). Hypothermia was associated with increased mortality (crude odds ratio [cOR] [95% CI] 2.02[1.84;2.21]; adjusted OR 1.55[1.29;1.87]). Subgroup and sensitivity analyses upheld these results. Meta-regression analysis showed an inversed relationship between effect size and BW. Hypothermia was associated with higher risks of BPD (cOR 1.13[1.01;1.27]), IVH (cOR 1.37[1.17;1.61]), ROP (cOR 1.55[1.41;1.69]), and sepsis (cOR 1.32[1.16;1.51]).LIMITATIONSOnly observational studies were included.CONCLUSIONSHypothermia is associated with increased mortality and morbidity in very preterm infants. The strength of this association may be influenced by BW, definitions of hypothermia and outcomes, and exclusion criteria. Given the robustness of our results and our sample size, identical cohort studies might not provide different insights.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"69 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866196","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}

引用次数: 0

Vaccines Matter: Measles and Its Complications.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-22 DOI: 10.1542/peds.2025-071622

Christopher Kuo

引用次数: 0

Pediatric Case of Crohn Disease, Immunoglobulin A Nephropathy, and Atopic Dermatitis.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-22 DOI: 10.1542/peds.2024-068803

Yoshihiko Sugino,Hideki Ban,Yuichiro Yoshino,Yugo Takaki,Akio Furuse

引用次数: 0

Persistent Poverty and Pediatric Cancer Survival.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-21 DOI: 10.1542/peds.2024-069973

Emma Hymel,Josiane Kabayundo,Krishtee Napit,Shinobu Watanabe-Galloway

{"title":"Persistent Poverty and Pediatric Cancer Survival.","authors":"Emma Hymel,Josiane Kabayundo,Krishtee Napit,Shinobu Watanabe-Galloway","doi":"10.1542/peds.2024-069973","DOIUrl":"https://doi.org/10.1542/peds.2024-069973","url":null,"abstract":"BACKGROUNDCancer is the leading cause of death by disease among US children. While previous studies have examined the impact of poverty on pediatric cancer outcomes, most relied on single time point measures, which may not capture the long-term, systemic effects of poverty. Persistent poverty, defined as having 20% or more of an area's population below the poverty level for 30 years, represents a more comprehensive measure of sustained socioeconomic disadvantage.METHODSIn this population-based study, we used Surveillance, Epidemiology, and End Results (SEER)-22 Registries Incidence Data with Census Tract Attributes Database data. Primary cases of cancer diagnosed among children from 2006 to 2020 were included. Cox proportional hazards models were used to compute the association between persistent poverty and (1) early mortality (death from cancer within 3 months of diagnosis) and (2) overall cancer-specific mortality.RESULTSIn total, 97 132 children were included in our study; 12.63% resided in a persistent-poverty neighborhood at diagnosis. In the adjusted models, living in a persistent-poverty neighborhood was associated with a higher risk of early mortality (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.10-1.45) and a higher risk of overall cancer death (aHR, 1.15; 95% CI, 1.10-1.21). Persistent poverty was associated with survival for children with leukemias (aHR, 1.20; 95% CI, 1.09-1.31), central nervous system tumors (aHR, 1.14; 95% CI, 1.04-1.26), and hepatic tumors (aHR, 1.37; 95% CI, 1.01-1.85).CONCLUSIONSOur study observed increased risk of cancer death among children in persistent-poverty neighborhoods. Continued investment and research are critical to developing effective strategies that reduce disparities and improve outcomes for pediatric cancer patients affected by persistent poverty.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"77 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857256","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}

引用次数: 0

Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-18 DOI: 10.1542/peds.2024-068565

Megan Rose Curtis,Sarah Munroe,Breanne E Biondi,Andrea L Ciaranello,Benjamin P Linas,Rachel L Epstein

{"title":"Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States.","authors":"Megan Rose Curtis,Sarah Munroe,Breanne E Biondi,Andrea L Ciaranello,Benjamin P Linas,Rachel L Epstein","doi":"10.1542/peds.2024-068565","DOIUrl":"https://doi.org/10.1542/peds.2024-068565","url":null,"abstract":"BACKGROUND AND OBJECTIVESPediatric HCV cases have increased in the United States. Guidelines recommend beginning treatment of HCV for children as young as 3 years old. However, no studies have evaluated pediatric linkage to HCV care and direct-acting antiviral (DAA) uptake on a national level. This study aims to characterize the HCV care cascade among a national cohort of children with HCV.METHODSThis retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. We analyzed TriNetX Research Network data, a US national electronic health records network. Primary HCV care cascade outcomes included the number of children diagnosed with HCV infection, linked to care, and prescribed DAAs. We assessed the association between race and ethnicity with linkage to care using logistic regression.RESULTSAmong 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA. Hispanic/Latinx children had double and white children had triple the odds of linkage compared with Black children (odds ratio [OR], 2.20; 95% CI, 1.05-4.59; OR, 3.44; 95% CI, 1.89-6.28) after adjusting for sex, birth cohort, and region.CONCLUSIONSPediatric access to HCV care remains low. Fewer than 1 in 3 children linked to HCV care and fewer than 1 in 8 were treated. This study uncovers racial and ethnic disparities in HCV care access. Targeting interventions toward increasing linkage to care could represent an opportunity to advance HCV elimination goals and reduce disparities.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"91 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849378","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}

引用次数: 0

Altered Mental Status and First-Time Seizure in Teen With a Subacute Inguinal Mass.

IF 8 2区医学

Pediatrics Pub Date : 2025-04-17 DOI: 10.1542/peds.2024-069855

Kassondra M Little,Emily Speck,Christian D Pulcini,Marianna Paradise,Molly Rideout,William V Raszka

{"title":"Altered Mental Status and First-Time Seizure in Teen With a Subacute Inguinal Mass.","authors":"Kassondra M Little,Emily Speck,Christian D Pulcini,Marianna Paradise,Molly Rideout,William V Raszka","doi":"10.1542/peds.2024-069855","DOIUrl":"https://doi.org/10.1542/peds.2024-069855","url":null,"abstract":"A healthy 13-year-old boy who resides in rural Vermont presented after witnessed, generalized seizure-like activity for approximately 2 minutes. He had been well until the development of right inguinal pain and rash 2 weeks before presentation, which had progressed to a 5-cm irregular, red, tender, and raised area that was unresponsive to 5 days of cephalexin. At the time of presentation, he was afebrile and hemodynamically stable and only responsive to localized stimuli. Initial laboratory evaluation, toxicology screening, and computed tomography of the head were all unremarkable. Ultrasonography of the inguinal lesion showed an abscess with subcutaneous edema and reactive lymphadenopathy. He did not have evidence of stroke or status epilepticus. Because of his persistent altered mental status, the patient was admitted to the pediatric intensive care unit, and pediatric infectious disease was consulted. A detailed history revealed he had extensive recent animal exposures that included bear, deer, dogs, chickens, and kittens. Cerebrospinal fluid (CSF) analysis showed 5 leukocytes (26% polymorphonuclear leukocyte), normal glucose, and slightly elevated protein. Video electroencephalogram demonstrated bilateral cerebral dysfunction, whereas the brain magnetic resonance imaging and magnetic resonance venogram scan results were normal. CSF culture and polymerase chain reaction results for bacterial and viral pathogens were negative. Fluid collected from the inguinal lesion showed neutrophils but no organisms. The following discussion describes this patient's full course, differential diagnoses, diagnostic workup with clinical reasoning, and final diagnosis.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"136 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846427","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}

引用次数: 0