Pediatrics最新文献

{"title":"Maternal RSV Vaccination, Infant Nirsevimab, or Both: Interim Analysis of a Randomized Trial.","authors":"Christina A Rostad, C Mary Healy, Jennifer L Nayak, Lalitha Parameswaran, C Buddy Creech, Judith M Martin, Rebecca C Brady, Kimberly Jones-Beatty, Martina Badell, Catherine Eppes, Michael Quinn, Mark Mulligan, Stephanie L Rolsma, Anne-Marie Rick, Braxton Forde, Vasanthi Avadhanula, Pedro A Piedra, Kalyani Telu, Pratap S Kunwar, Jinjian Mu, Fei Gao, Marcela F Pasetti, Britta Flach, Christine M Posavad, Joy Miedema, Jeanna M Piper, Sonnie Kim, Tatiana Beresnev, Cristina Cardemil, James D Campbell","doi":"10.1542/peds.2025-075223","DOIUrl":"https://doi.org/10.1542/peds.2025-075223","url":null,"abstract":"<p><p></p><p><strong>Background: </strong>Although both maternal respiratory syncytial virus (RSV) prefusion F vaccination (RSVpreF) and infant nirsevimab immunization have been approved for the prevention of RSV lower respiratory tract infections, the 2 have not been evaluated in a single study, and their sequential administration has not been studied systematically.</p><p><strong>Methods: </strong>We performed a prospective, randomized, open-label, phase 4 study at 8 US sites of mother-infant pairs randomized 1:1:1:1 during pregnancy: maternal RSVpreF vaccine alone, maternal RSVpreF vaccine/infant nirsevimab at birth, maternal RSVpreF vaccine/infant nirsevimab at 3 months, or infant nirsevimab alone at birth. We are following the mother-infant pairs for 12 months to ascertain safety, infant tolerability, and the magnitude and durability of RSV-A and -B neutralizing antibodies (nAbs). We report interim data from September 19, 2024, to May 15, 2025, including 4-month infant follow-up.</p><p><strong>Results: </strong>In total, 181 mothers were enrolled. Both products alone and in combination were safe. No related serious adverse events were observed in mothers or infants. Nirsevimab was well tolerated, and all local and systemic reactogenicity was mild to moderate in severity. RSVpreF vaccination boosted maternal RSV-A nAb titers 17.35-fold at the time of delivery, and titers were durable through 3 months postdelivery. The geometric mean transfer ratio of RSV-A nAbs was higher than 1.3 and similar across groups. RSV nAbs were highly elevated in infants at 6 weeks and 3 months, irrespective of group, with modest differences in waning.</p><p><strong>Conclusions: </strong>Maternal RSVpreF vaccine and infant nirsevimab administration, either alone or in combination, were safe and provided high RSV nAb titers in infants through interim follow-up.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819458","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":"Reducing the Impact of RSV in Infants: Vaccinate Mothers, Passively Immunize Newborns, or Both?","authors":"Michael Rajnik, Martin Ottolini","doi":"10.1542/peds.2025-075676","DOIUrl":"https://doi.org/10.1542/peds.2025-075676","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819486","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":"Integrating Social and Emotional Care Across the First Thousand Days in Safety-Net Health Care.","authors":"Yonit Lax, Annika Brauer, Jamie Canton, Jeremy Silverstein, Sydney Umansky, Michael Silver, Vivian Durzieh, Kelsie Okamura","doi":"10.1542/peds.2025-072654","DOIUrl":"https://doi.org/10.1542/peds.2025-072654","url":null,"abstract":"<p><p></p><p><p>Although the first thousand days are recognized as a critical period, health clinicians struggle to adequately address unmet social and emotional needs during this time, and attempts to do so are often siloed. To create a collaborative, population-based model, our hospital committed to integrating interdisciplinary social and emotional care continuously wherever patients were routinely seen for medical care at 3 touchpoints (prenatally, mother-baby unit/neonatal intensive care unit, and pediatric well-child visits) through the Brooklyn Parenting Center (BPC). We describe how the BPC adapted Strengthening Families' 5 principles of protective factors to change maternal-child health in our hospital via (1) providing universal access to continuous integrated social and emotional support throughout the first thousand days; (2) using evidence-based models to address unmet social and emotional needs; and (3) supporting parents to become the caregivers they want to be through optimizing positive development for their children. We further describe implementation steps, successes, and lessons learned that could apply in other health care settings. Implementing and sustaining the BPC required coalition building and advocacy in the community and across multiple departments within the hospital. Through collaboration with a community advisory board, the BPC created a population-based model of care with a trauma-informed lens to detect needs and provide support in a patient-centered manner. Efforts to continue optimizing outcomes will require including family input, increasing the workforce to meet the demand uncovered by these efforts, and building on current sustainability plans to make a case for increased cost savings measures in the face of bundled care.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819465","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":"Correction to Postnatal Cord Blood Sampling: Clinical Report.","authors":"","doi":"10.1542/peds.2026-076151","DOIUrl":"10.1542/peds.2026-076151","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146259003","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":"Comparison of Cervical Spine Injury Prediction Rule Across Ages.","authors":"Daniel J Corwin, Pradip P Chaudhari, Leah Tzimenatos, Monica Harding, Lawrence Cook, Kenneth Yen, Alexander Rogers, Fahd A Ahmad, Robert Sapién, Robert Hickey, Lois Lee, Jeffrey R Leonard, Julie C Leonard","doi":"10.1542/peds.2025-075341","DOIUrl":"10.1542/peds.2025-075341","url":null,"abstract":"<p><p></p><p><strong>Objective: </strong>To evaluate the performance of the Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) prediction rule among different pediatric age groups and derive and assess age-specific CSI prediction rules.</p><p><strong>Methods: </strong>We conducted a planned secondary analysis of the PECARN CSI study of children younger than 18 years with known or suspected blunt trauma evaluated at 1 of 18 children's hospitals' emergency departments. Participants were divided into 4 clinically relevant age groups (<2, 2-7, 8-15, and 16 to <18 years). Age-specific rules were derived from the 4 high-risk predictors of the PECARN CSI Prediction Rule and using a classification and regression tree (CART) analysis to identify additional non-negligible age-specific risk factors. Rule performance was assessed using sensitivity, specificity, and positive and negative predictive values (NPVs) for each age group.</p><p><strong>Results: </strong>There were 22 430 participants included in analysis. Three to 8 risk factors were identified as non-negligible risk in CART analysis for each age-specific rule. The sensitivity of the PECARN CSI Prediction Rule (range 91.7%-94.4% across age groups) was similar to age-specific rules (range 88.4%-97.5%). The specificity of the PECARN CSI Prediction Rule (range 44.6%-72.3% for age groups) was also similar to age-specific rules (range 45.9%-75.9%). NPVs (all ≥99.6%) were similar across age groups for all rules.</p><p><strong>Conclusions: </strong>Rule performance for the age-specific CSI prediction rules and the PECARN CSI Prediction Rule were similar. These findings support clinicians' use of the PECARN CSI Prediction Rule across the pediatric age spectrum.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819447","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":"Hepatitis B Vaccination at Birth: Safety, Effectiveness, and Public Health Benefit.","authors":"Angela K Ulrich, Derek F Fleming, Emily A Smith, Cory J Anderson, Angela J Mehr, Sydney G Redepenning, Clare J Stoddart, Leah E Moat, Rochelle P Walensky, Eve M Lackritz","doi":"10.1542/peds.2025-075783","DOIUrl":"10.1542/peds.2025-075783","url":null,"abstract":"<p><p></p><p><p>Since 1991, the CDC has recommended screening for hepatitis B virus (HBV) infection in pregnancy and universal hepatitis B vaccination of all medically stable infants at birth, serving as a core strategy to prevent perinatal and postnatal infection and eliminate HBV transmission nationwide. On December 5, 2025, the Advisory Committee on Immunization Practices (ACIP) voted (1) among women who screen negative in pregnancy, parents decide, in consultation with providers, when or if to vaccinate their child for hepatitis B, and if not at birth, then aged no earlier than 2 months, and (2) consider collection of infant immune titers to guide decision-making for completing the vaccine series. We conducted a comprehensive review of the evidence on the safety, immunogenicity, efficacy, and effectiveness of the birth dose and a delayed first dose, and of the potential role of serology for clinical decision-making. We analyzed studies of the epidemiology of HBV infection, clinical trials, systematic reviews, vaccine safety from surveillance and clinical studies, and the potential impact of revised guidelines on individual and public health. We synthesized the history of ACIP recommendations and resulting trends in HBV incidence. The review found strong evidence for the safety and effectiveness of the birth dose, and no improvement in safety or effectiveness with a delayed first dose. We found no evidence to support the use of postvaccination serology. Infant vaccination has resulted in a 99% reduction in pediatric HBV infections; we found no evidence to support a change in vaccine recommendations but identified potential health consequences.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119764","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":"Pneumococcal Pneumonia: Understanding the Past to See the Future.","authors":"Adam J Ratner","doi":"10.1542/peds.2025-075677","DOIUrl":"https://doi.org/10.1542/peds.2025-075677","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"151 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751228","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":"Framework for Approaching Healthy Mental and Emotional Development in Pediatrics: Clinical Report.","authors":"Evelyn Berger-Jenkins,Jennifer K Poon,Kathleen Hobson Davis,Amy Starin,Rachel Segal,Arthur Lavin, , ","doi":"10.1542/peds.2026-076620","DOIUrl":"https://doi.org/10.1542/peds.2026-076620","url":null,"abstract":"Despite widespread recognition that mental and emotional concerns in childhood have risen to an unprecedented high, there continues to be a sense of hesitancy in approaching mental and emotional development in pediatrics. This hesitancy is related to pervasive barriers including lack of comfort, time, and perhaps most importantly, lack of resources to offer families. However, research supports that families benefit from interventions that foster healthy relationships and whole health throughout development, which are fundamental to pediatric practice. Pediatricians are skilled in addressing whole health as they support the physical, mental, emotional, developmental, and social well-being of families from the birth of a child to their transition into adulthood. They are also accustomed to assessing health on a spectrum that includes prevention, early identification, treatment, and support as they work through concerns and diagnoses with families in an iterative manner and over the long-term. This type of practice that focuses less on expeditiously arriving at diagnoses and narrow treatments for concerns is important for mental and emotional development. This report presents a reframe of mental and emotional development as part of whole health as opposed to a condition that should only be diagnosed and treated when something is \"wrong.\" The report also provides a stepped approach that may be helpful for addressing mental and emotional health concerns in pediatrics and acknowledges the advocacy that is needed to expand mental and emotional resources widely.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751229","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":"Estimating Costs to Families Facing Changes to ACA-Enhanced Premium Tax Credits.","authors":"Nicolas P Goldstein Novick,Brielle Formanowski,Scott A Lorch,Timothy D Nelin,Diana Montoya-Williams,Abigail B Wilpers,Elizabeth G Salazar","doi":"10.1542/peds.2026-076871","DOIUrl":"https://doi.org/10.1542/peds.2026-076871","url":null,"abstract":"BACKGROUND AND OBJECTIVESEnhanced premium tax credits (PTCs) for Affordable Care Act Marketplace plans expired in 2026. We described families across income groups potentially affected by PTC policy changes and simulated net premiums.METHODSWe performed a cross-sectional simulation using the 2023 National Survey of Children's Health, classifying families by federal poverty level (FPL) into the following income groups: ineligible (above state Medicaid threshold, <100% FPL), Medicaid (below state threshold), 100-<250% FPL, 250-<400% FPL, and ≥400% FPL. We estimated family premiums using scaled state benchmarks and modeled net premium costs under (1) enhanced PTCs, (2) enhanced PTC expiration, and (3) PTC repeal using ordinary least squares regression adjusting for state fixed effects and family sociodemographics.RESULTSFamilies in PTC-relevant income groups had greater material hardship and children with more health conditions but less access than higher-income families. With typical family ages, adjusted net premiums as a percentage of income would be 1.8% (100-<250% FPL), 6.3% (250-<400% FPL), and 8.4% (≥400% FPL) with enhanced PTCs; 6.2%, 9.5%, and 15.2% post-expiration; and 27.1%, 17.8%, and 13.7% with repealed PTCs. In 2023 dollars, net premiums would be $1,335, $6,137, and $9,705 with enhanced PTCs; $4,100, $9,056, and $17,711 post-expiration; and $15,963, $17,069, and $16,903 with no PTCs.CONCLUSIONS AND POLICY IMPLICATIONSEnhanced PTC expiration would increase net premiums substantially, particularly for ≥400% FPL families; full PTC repeal would produce large, regressive premium burdens for lower-income families with children. PTCs should be re-enhanced and not repealed to support American families.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"41 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751226","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":"Pneumococcal Pneumonia in Hospitalized Children: 2017-2023.","authors":"Eric E Engstrom,Sheldon L Kaplan,William J Barson,Philana Ling Lin,Steven Dahl,John S Bradley,Pia S Pannaraj,Tina Q Tan,Jennifer Dien Bard,Kacy Ramirez,Lindsay R Grant,Adriano Arguedas,Maria J Tort,Ashley Miller,Alejandro Cané,Kristina G Hulten","doi":"10.1542/peds.2025-073196","DOIUrl":"https://doi.org/10.1542/peds.2025-073196","url":null,"abstract":"OBJECTIVESWe hypothesized that the incidence, clinical presentation, isolate serotypes, and isolate antibiotic susceptibility of Streptococcus pneumoniae causing pneumonia in children varied before and through the course of the COVID-19 pandemic.METHODSPatients aged 18 years or younger at 8 children's hospitals in the United States admitted with culture-positive pneumonia were identified. Serotyping of pneumococcal isolates was performed at a central research laboratory. Clinical and laboratory data were collected retrospectively with a standardized case report form.RESULTSWe identified 190 patients with pneumococcal pneumonia from 2017 to 2023. Cases decreased significantly in 2020 (P < .05), with a surge in 2022 and 2023. Serotype 3 was the most common serotype, was prominent after 2021, and was associated with a significantly higher rate of empyema and necrotizing parenchyma (P < .001). PCV13 serotypes 3, 19A, and 19F constituted over half of isolates; new serotypes in PCV15 (22F and 33F) and PCV20 (8, 10A, 11A, 12F, 15B, 22F, and 33F) accounted for 14% and 22% of isolates, respectively. Penicillin susceptibility (minimum inhibitory concentration [MIC] ≤ 2 μg/mL) was very common (94% of isolates), and all 11 isolates with MIC greater than 2 μg/mL were serotype 19A. Of those tested, 90 patients had viral coinfections; only influenza was associated with more pneumonia complications compared with patients without influenza (P = .002).CONCLUSIONSS pneumoniae remains an important cause of pneumonia in children with the potential for severe infections. After 2020, increasing rates have primarily been due to serotype 3, while β-lactam resistance was largely associated with serotype 19A. PCV15 and PCV20 may modestly reduce pneumococcal pneumonia incidence further.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"8 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751237","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}