Pediatrics最新文献

{"title":"Supporting Children's Mental Health Needs in Disasters.","authors":"Jennifer A Hoffmann, Alba Pergjika, Kimberly Burkhart, Christopher Gable, Ashley A Foster, Mohsen Saidinejad, Trevor Covington, Desiree Edemba, Sara Mullins, Merritt Schreiber, Lee S Beers","doi":"10.1542/peds.2024-068076","DOIUrl":"10.1542/peds.2024-068076","url":null,"abstract":"<p><p>Public health emergencies, including climate-related and manmade disasters such as active shooter incidents, occur regularly in the United States. A comprehensive approach is needed to ensure that children's mental health needs are adequately addressed following disasters. This article summarizes the latest evidence on how health systems can effectively address children's unique developmental, social, emotional, and behavioral needs in the context of disasters. To do so requires the integration of mental health considerations throughout all disaster phases, including preparedness, response, and recovery. We discuss the role of traditional emergency response systems and emerging models for responding to mental health crises. These include the national children's disaster mental health concept of operations and specific resources such as crisis lines, mobile crisis units, and telemental health. To achieve a broader reach in addressing children's mental health needs during disasters, health systems can foster a \"pediatric disaster system of care\" by partnering with community touch points such as schools, faith-based organizations, public health, and law enforcement. Unique considerations during disasters are required to maintain access to care for children with preexisting behavioral health conditions. During disasters, attention is needed to promote equitable identification of mental health needs and linkage to services, particularly for minoritized groups and children living in rural, frontier, and high-poverty areas. Strategies to address children's mental health needs during disasters include the provision of psychological first aid, screening for and triaging mental health needs, and stepped care approaches that progressively allocate higher-intensity evidence-based treatments to children with greater and enduring needs.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity-Focused Interventions Improve Interpreter Use in the Pediatric Intensive Care Unit.","authors":"Lena Oliveros, Hector Valdivia, Colin Crook, Lori Rutman, Surabhi Vora, Dwight Barry, Lauren Rakes","doi":"10.1542/peds.2023-065427","DOIUrl":"10.1542/peds.2023-065427","url":null,"abstract":"<p><strong>Background: </strong>Federal guidelines and equitable care mandate that patients who use a language other than English receive interpretation in their preferred language. Substantial variability exists in interpreter use in intensive care settings. We aimed to increase the rate of interpretations in our pediatric intensive care unit (PICU) through a series of targeted interventions.</p><p><strong>Methods: </strong>A multidisciplinary team developed a key driver diagram to identify areas for focused intervention. Each plan-do-study-act cycle informed the next cycle of interventions, targeting increasing interpreter (video, phone, and in-person) use. Interventions included standardizing technology, standardizing placement of interpretation devices in patient rooms, provider education, and creating accountability systems of interpreter use by care providers. We reviewed data from PICU encounters between January 2018 and January 2022 and used summary statistics and statistical process control methods to measure the impact of our interventions.</p><p><strong>Results: </strong>We analyzed 882 patient encounters over the 4-year study period. Demographic characteristics were similar in the preintervention and postintervention periods. The total interpretation rate increased to 2.7 interpretations per patient per day from a baseline rate of 1.4. Each individual interpretation modality demonstrated increases in use. Average time spent interpreting via phone increased from 8 to 10.5 minutes per patient per day, and average time spent interpreting via video went from 9.5 to 22 minutes per patient per day.</p><p><strong>Conclusions: </strong>Iterative quality improvement methodology effectively identified barriers to equitable care, guided development of focused interventions, and improved interpreter use among pediatric patients who were critically ill.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771244","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":"Nirsevimab Effectiveness Against Severe Respiratory Syncytial Virus Infection in the Primary Care Setting.","authors":"Mónica López-Lacort, Cintia Muñoz-Quiles, Ainara Mira-Iglesias, F Xavier López-Labrador, María Garcés-Sánchez, Begoña Escribano-López, Matilde Zornoza-Moreno, Jaime Jesús Pérez-Martín, Santiago Alfayate-Miguelez, Antonio Iofrío-De Arce, Eliseo Pastor-Villalba, José Antonio Lluch-Rodrigo, Javier Díez-Domingo, Alejandro Orrico-Sánchez","doi":"10.1542/peds.2024-066393","DOIUrl":"10.1542/peds.2024-066393","url":null,"abstract":"<p><p></p><p><strong>Objectives: </strong>This study assesses the effectiveness of nirsevimab, a monoclonal antibody, in preventing medically attended respiratory syncytial virus-lower respiratory tract infections (RSV-LRTIs) in a large primary care network in Spain, in both overall and catch-up infants aged younger than 10 months.</p><p><strong>Methods: </strong>The 2023-2024 immunization campaign with nirsevimab in Spain targeted all infants born after April 1, 2023. Those born after October 1 received it at birth in hospitals, whereas others received it through a catch-up program. The MEDIPRIM network of primary care centers recruited all infants with LRTI for RSV polymerase chain reaction testing and employed a test-negative design approach to estimate the effectiveness of nirsevimab.</p><p><strong>Results: </strong>The study included 160 infants; 141 (88%) of them received nirsevimab and 128 belonged to the catch-up group (88% received nirsevimab). Overall, RSV was detected in 44 infants (27.5%). Within the catch-up group, 37 (28.9%) were positive for RSV. The overall effectiveness was 75.8% (95% credible interval: 40.4-92.7), and 80.2% (95% credible interval: 44.3-95.4) in infants belonging to the catch-up group.</p><p><strong>Conclusions: </strong>This study underscores the effectiveness of nirsevimab in preventing medically attended LRTI in infants in outpatient settings and emphasizes the importance of a catch-up immunization program to reduce the disease burden in primary care.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372525","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":"Risk of Transmission of Vaccine-Strain Rotavirus in a Neonatal Intensive Care Unit That Routinely Vaccinates.","authors":"Morgan A Zalot, Margaret M Cortese, Kevin P O'Callaghan, Mary C Casey-Moore, Nathan L'Etoile, Sarah Leeann Smart, Michelle J Honeywood, Slavica Mijatovic-Rustempasic, Jacqueline E Tate, Anna Davis, Nicole Wittmeyer, Carolyn McGann, Salma Sadaf, Kadedra Wilson, Michael D Bowen, Rashi Gautam, Umesh D Parashar, Susan E Coffin, Kathleen A Gibbs","doi":"10.1542/peds.2024-067621","DOIUrl":"10.1542/peds.2024-067621","url":null,"abstract":"<p><p></p><p><strong>Background and objectives: </strong>Many neonatal intensive care units (NICUs) do not give rotavirus vaccines to inpatients due to a theoretical risk of horizontal transmission of vaccine strains. We aimed to determine incidence and clinical significance of vaccine-strain transmission to unvaccinated infants in a NICU that routinely administers pentavalent rotavirus vaccine (RV5).</p><p><strong>Methods: </strong>This prospective cohort study included all patients admitted to a 100-bed NICU for 1 year. Stool specimens were collected weekly; real-time quantitative reverse-transcription polymerase chain reaction was used to detect any RV5 strain. Incidence of transmission to unvaccinated infants was calculated assuming each unvaccinated patient's stool contributed 1 patient-day at risk for transmission. Investigations and geospatial analyses were conducted for suspected transmission events.</p><p><strong>Results: </strong>Of 1238 infants admitted, 560 (45%) were premature and 322 (26%) had gastrointestinal pathology. During observation, 226 RV5 doses were administered. Overall, 3448 stool samples were tested, including 2252 from 686 unvaccinated patients. Most (681, 99.3%) unvaccinated patients never tested positive for RV5 strain. Five (<1%) tested RV5 strain positive. The estimated rate of transmission to unvaccinated infants was 5/2252 stools or 2.2/1000 patient-days at risk (95% CI: 0.7-5.2). No gastroenteritis symptoms were identified in transmission cases within 7 days of collection of RV5-positive stool. Of 126 patients for whom the RV5 series was initiated before the discharge date, 55% would have become age-ineligible to start the series if vaccination was allowed only at discharge.</p><p><strong>Conclusions: </strong>Transmission of RV5 strain was infrequent and without clinical consequences. Benefits of allowing vaccine-induced protection against rotavirus disease in infants through in-NICU RV5 vaccination appear to have outweighed risks from vaccine-strain transmission.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801986","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":"Infant Feeding Disparities Amid the Formula Shortage: Where Do We Go From Here?","authors":"Rita Wang,Neha S Anand,Heather E Hsu","doi":"10.1542/peds.2024-068835","DOIUrl":"https://doi.org/10.1542/peds.2024-068835","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"62 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142888160","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":"Breastfeeding Trends Following the US Infant Formula Shortage.","authors":"Luis Seoane Estruel,Tatiana Andreyeva","doi":"10.1542/peds.2024-067139","DOIUrl":"https://doi.org/10.1542/peds.2024-067139","url":null,"abstract":"OBJECTIVEBreastfeeding enhances maternal and child health, yet US breastfeeding rates remain below optimal levels and substantial disparities persist. The 2022 infant formula crisis had the potential to influence infant feeding practices due to formula shortages and fears about the safety of formula feeding in the wake of recalls. This report studies the evolution of breastfeeding-initiation trends during the infant formula crisis and compares the effects across subpopulations.METHODSThis study analyzed 2016-2022 national birth certificate data from 47 states and the District of Columbia based on Bayesian structural time-series analysis to measure average changes in breastfeeding-initiation trends and a linear probability model to test for heterogeneous effects.RESULTSDuring the 2022 infant formula crisis, average breastfeeding-initiation rates increased by 1.96 percentage points (pp) (95% credible interval, 1.68 pp to 2.23 pp) and remained elevated above historical levels at the end of the formula crisis. The increase was particularly pronounced among mothers with lower education levels, those receiving Special Supplemental Nutrition Program for Women, Infants, and Children assistance, residents of less populated counties, Medicaid recipients, and Black mothers, possibly due to their higher reliance on formula feeding. Populations meeting all of these sociodemographic criteria experienced the largest increase in breastfeeding initiation at 6.06 pp (95% confidence interval, 5.26 pp to 6.87 pp). Preexisting disparities in breastfeeding initiation declined in 2022.CONCLUSIONThe infant formula crisis highlights the potential for addressing breastfeeding disparities and reducing associated child and maternal health risks through targeted interventions to promote breastfeeding.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"22 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142888166","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":"Bereaved Parents' Perceptions of the Doll Reenactment After Sudden Unexpected Infant Deaths.","authors":"Pål Kristensen,Atle Dyregrov,Torleiv O Rognum,Richard D Goldstein","doi":"10.1542/peds.2024-066731","DOIUrl":"https://doi.org/10.1542/peds.2024-066731","url":null,"abstract":"BACKGROUND AND OBJECTIVESA death scene investigation is required to determine sudden infant death syndrome, and a doll reenactment optimizes the information obtained. The aim of this study was to explore how acutely bereaved parents experience doll reenactments that are conducted after the sudden and unexpected deaths of their infants.METHODSA mixed-methods design, including surveys and semi-structured interviews, was used in a cross-sectional, national study to explore the experiences of doll reenactment among 45 bereaved parents.RESULTSForty-four percent of parents reported moderate to high distress during the doll reenactment, with significantly heightened distress in those who discovered their child lifeless and who later reported posttraumatic intrusions. An analysis of parents' narratives showed that the doll reenactment was challenging, particularly because of the doll's appearance and the activation of intrusive images in those who found their child lifeless. Parents overall experienced less distress than anticipated during the reenactment, and no lasting difficulties were reported. Some parents identified benefits from the reenactment, such as sharing a coherent narrative of the death. The parents' reactions to the doll reenactment were multifaceted and complex.CONCLUSIONThese findings illuminate the emotional challenges parents face during a doll reenactment and emphasize the delicate balance between obtaining crucial information and avoiding additional trauma in the aftermath of infant deaths. Because the doll reenactment's diagnostic utility or benefits to post-loss coping are uncertain, anticipatory guidance about its psychological dimensions may mitigate distress, and incorporating a gateway for professional support may further align it with the needs of acutely bereaved parents.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"141 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142888172","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":"CRKL Gene Deletion in Familial Zinner (OSVIRA) and OHVIRA Syndromes.","authors":"Hannah L Rhodes,Lucy Bownass,Sarah F Smithson,Mark N Woodward","doi":"10.1542/peds.2024-068135","DOIUrl":"https://doi.org/10.1542/peds.2024-068135","url":null,"abstract":"We present the first description of a family in which 2 siblings show alternative expression of CRKL gene deletion as the phenotypes of Zinner (OSVIRA, obstructed seminal vesicle and ipsilateral renal agenesis) and OHVIRA (obstructed hemivagina with an ipsilateral renal anomaly) syndromes. The male infant with Zinner syndrome and his sister aged 5 years with OHVIRA syndrome both have a paternally inherited 703-kb deletion at chromosome 22q11.21 that includes CRKL. This observation supports Acien's hypothesis that the upper vagina has an embryological dual origin and furthermore substantiates the theory that Zinner (OSVIRA) is the male equivalent of OHVIRA in females.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"14 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142888167","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":"Pediatric Climate Action for Our Children.","authors":"Sandra H Jee,Lisa Patel","doi":"10.1542/peds.2024-068812","DOIUrl":"https://doi.org/10.1542/peds.2024-068812","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142888230","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":"Extreme Heat Stress and Unplanned Hospital Admissions.","authors":"Wen-Qiang He,Gavin Pereira,Nan Hu,Raghu Lingam,Lindsey Hunt,Adrienne Gordon,Ollie Jay,Natasha Nassar","doi":"10.1542/peds.2024-068183","DOIUrl":"https://doi.org/10.1542/peds.2024-068183","url":null,"abstract":"OBJECTIVESThe burden and health impact of heat stress on child hospitalization is limited. This study aims to investigate associations between extreme heat stress exposure based on a Universal Thermal Climate Index (UTCI), emergency department (ED) visits, and ED visits that translate into unplanned hospital admissions.METHODSThis population-based case-crossover study included all ED visits and unplanned hospital admissions among children and adolescents aged 0 to 18 years from New South Wales, Australia, from July 2001 to June 2020. Heat stress was measured by heatwave days defined as 2 consecutive days or more with daily maximum UTCI in the 95th percentile or higher. Distributed lag nonlinear regression models with a quasi-Poisson distribution were applied, and the relative risks from the models were presented.RESULTSTotals of 8 240 170 ED visits and 1 427 736 unplanned hospital admissions were recorded. Compared with nonheatwave days, heatwave days were associated with an increased risk of ED visits and hospital admissions due to infectious diseases and infectious enteritis by 5% to 17% and heat-related illness by 78% to 104%. Findings were consistent for subgroup analyses. Children aged younger than 1 year and those from the most disadvantaged areas were more vulnerable to heat-related illness on heatwave days. Effects on hospitalization were attenuated using ambient temperature only.CONCLUSIONSThis study provides evidence of the effectiveness of UTCI to more completely demonstrate the harmful impact of extreme heat stress on increased infection and heat-related hospitalizations among children, which were not fully captured by using ambient temperature alone. Findings can inform targeted area-based strategies, particularly among vulnerable groups to mitigate the effects of extreme heat events.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"3 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142888173","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}