Pediatrics最新文献

{"title":"State-Based Eviction Moratoria and Child Maltreatment During the COVID-19 Pandemic.","authors":"Liwei Zhang, Yi Wang, Lawrence M Berger","doi":"10.1542/peds.2024-068174","DOIUrl":"https://doi.org/10.1542/peds.2024-068174","url":null,"abstract":"<p><p></p><p><strong>Objectives: </strong>The COVID-19 pandemic and associated economic crisis increased housing difficulties for families in the United States, putting children at increased risk of eviction and Child Protective Services involvement. For the first time at the national level, policymakers issued eviction moratoria with implementation approaches varying across states. This study examined whether state-based eviction moratoria were associated with changes in child maltreatment report rates.</p><p><strong>Methods: </strong>This study used child maltreatment report data from 318 counties in 17 states from January 1, 2019 to mid-August 2021. Difference-in-differences analyses were conducted to compare changes in maltreatment rates in counties that continuously implemented eviction moratoria with those that never did during the study period. County rates of overall child maltreatment, physical abuse, sexual abuse, and neglect were measured at the biweekly level using administrative data from the National Child Abuse and Neglect Data System.</p><p><strong>Results: </strong>Eviction moratoria were significantly associated with reduced biweekly reports of physical abuse (b [coefficient estimate] = -0.073; 95% CI, -0.119 to -0.027), sexual abuse (b = -0.034; 95% CI, -0.051 to -0.018), and neglect (b = -0.217; 95% CI, -0.346 to -0.088), representing reductions of physical abuse, sexual abuse, and neglect by 16.04%, 21.12%, and 12.17%, respectively. Eviction moratoria were negatively associated with overall child maltreatment report rates, but the coefficient was not statistically significant.</p><p><strong>Conclusions: </strong>Eviction moratoria may help prevent child maltreatment. Policymakers may consider providing sustainable housing assistance to support financially struggling families, both immediately following a public health crisis and over the long run.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803964","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":"Incidence of Medical Complexity in Military-Connected Children.","authors":"JoAnna K Leyenaar, Jackielyn Lanning, Celeste J Romano, David C Goodman, Andrew P Schaefer, Jordan A Taylor, Anna T Bukowinski, Gia R Gumbs, Elizabeth M Perkins, Monica A Lutgendorf, A James O'Malley, Ava Marie S Conlin, Clinton Hall","doi":"10.1542/peds.2024-069653","DOIUrl":"https://doi.org/10.1542/peds.2024-069653","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children with medical complexity (CMC) are at substantially increased risk for adverse health outcomes and mortality, justifying programs and policies to support their specialized needs. To inform such efforts, this study estimated the cumulative incidence of CMC-defining diagnoses by age 60 months in a cohort of live births among US military families and measured associations between birth outcomes and these diagnoses.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed Department of Defense Birth and Infant Health Research program data from 2005 to 2020. Health care claims were used to identify CMC born between 2005 and 2015 and diagnosed from birth until age 60 months using the Complex Chronic Condition Classification System and Pediatric Medical Complexity Algorithm. The cumulative incidence of medical complexity was estimated, and Fine-Gray regression models calculated adjusted hazard ratios (aHRs) and 95% CIs for associations between birth outcomes and CMC-defining diagnoses.</p><p><strong>Results: </strong>Among 975 233 live births, the estimated cumulative incidence of CMC-defining diagnoses by age 60 months was 12.0% (95% CI, 11.9-12.1, n = 108 133), with one-third diagnosed during the neonatal period and almost two-thirds diagnosed during infancy. Risk was highest for children born with vs without congenital anomalies (aHR = 25.2; 95% CI, 24.4-25.9), very preterm vs nonpreterm (aHR = 17.6; 95% CI, 17.0-18.2), and very low birthweight vs normal/high birthweight (aHR = 13.7; 95% CI, 13.3-14.2).</p><p><strong>Conclusions: </strong>Approximately 1 in 9 military-connected children were diagnosed with complex medical conditions by age 5, with risk highly associated with preterm delivery, congenital anomalies, and low birthweight. These findings can inform clinical counseling and justify resource allocation to support this population.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803962","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 Subsequent Pneumonia After a Negative Chest Radiograph in the ED.","authors":"Alexander W Hirsch, Ariella Wagner, Susan C Lipsett, Michael C Monuteaux, Mark I Neuman","doi":"10.1542/peds.2024-069829","DOIUrl":"https://doi.org/10.1542/peds.2024-069829","url":null,"abstract":"<p><strong>Background: </strong>Although chest radiograph (CXR) is frequently used to diagnose pneumonia, there is concern that radiographic findings may lag clinical findings, raising doubt around the reliance on CXR. This study sought to determine the percentage of children that develop radiographic pneumonia after an initially normal CXR, and to describe the characteristics of these patients.</p><p><strong>Methods: </strong>This is a retrospective cohort study in a large tertiary pediatric emergency department (ED) over a 10-year period. Children younger than 21 years of age with suspected pneumonia whose initial CXR was negative and who underwent another CXR within 14 days were included in the study. Children with certain chronic medical conditions and those admitted to an intensive care unit were excluded.</p><p><strong>Results: </strong>Among 9957 children with suspected pneumonia and a normal CXR in the ED, 240 underwent a follow-up CXR within 14 days, of whom 27 children (11% of children with a second CXR) had developed radiographic pneumonia. Tachypnea, hypoxemia, and dehydration were found to be predictors of radiographic pneumonia after an initially normal CXR.</p><p><strong>Conclusions: </strong>The development of radiographic pneumonia following a normal CXR is rare in the ED setting. Clinicians can rely on the CXR to exclude a diagnosis of pneumonia in the ED setting but may exercise more caution in children with certain clinical features.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796141","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 Universal Suicide Risk Screening Rates at a Children's Hospital.","authors":"Anna Lund, Kimberly Denicolo, Skyler Tomko, Roderick C Jones, Rebecca J Stephen, Michael Olsen, John Sarmiento, Stephanie Jones, Ellen DiVenere, Naomi Sullivan, Agata Nytko, Jennifer Hoffmann","doi":"10.1542/peds.2024-065901","DOIUrl":"https://doi.org/10.1542/peds.2024-065901","url":null,"abstract":"<p><strong>Background and objectives: </strong>Suicide is a leading cause of death among US youth. In hospital settings, screening for suicide risk enables assessment, brief interventions, and linkage to treatment. Our objective was to increase compliance with universal suicide risk screening for patients aged 10 years or older during acute care visits (to the emergency department [ED] and/or inpatient medical units) of a children's hospital from 27% to greater than or equal to 60% over 13 months.</p><p><strong>Methods: </strong>Using quality improvement methodology, a multidisciplinary team implemented interventions to increase compliance with universal suicide risk screening for patients aged 10 years or older at an academic children's hospital from June 2022 to June 2023, followed by a 7-month sustainment period. Interventions included a clinical care guideline and clinical decision support tools embedded in the electronic health record (EHR). We measured compliance with administration of Ask Suicide-Screening Questions (ASQ) during eligible visits, overall and stratified by care area, and positivity rates.</p><p><strong>Results: </strong>During the intervention and sustainment periods, there were 18 435 and 10 257 acute care visits by patients aged 10 years or older, respectively. Screening compliance rates increased from 27% to 80% overall, from 17% to 80% in the ED, and from 55% to 76% in inpatient medical units. Of acute care visits with screening performed during the sustainment period, 8.6% had positive ASQ screening (6.9% nonimminent risk and 1.7% imminent risk).</p><p><strong>Conclusions: </strong>Implementing a clinical care guideline, accompanied by EHR-integrated clinical decision support, increased compliance with suicide risk screening at a children's hospital. Screening positivity rates reflect mental health needs among children receiving acute care.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780829","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":"Disparities in Pediatric Emergency Department Triage Among Encounters Resulting in Admission.","authors":"Jamie K Lim, Michael Harries, Patrick Hebert, Selina Varma Thomas","doi":"10.1542/peds.2024-069598","DOIUrl":"https://doi.org/10.1542/peds.2024-069598","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780827","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":"Neuropsychological Functioning in Pediatric Primary Headache Disorders: A Meta-Analysis.","authors":"Jasmin H Pizer, Katherine A Hernandez, Stephen L Aita, Vasilios C Ikonomou, Melissa A Myers, Nanako A Hawley, Kyle M Brasil, Nicholas C Borgogna, Jamie A Spiegel, Todd A Smitherman, Benjamin D Hill","doi":"10.1542/peds.2024-067838","DOIUrl":"https://doi.org/10.1542/peds.2024-067838","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether neuropsychological functioning was impaired among individuals with pediatric primary headache disorders (PHD) compared with individuals without headaches. Adults with migraine appear to evidence deficits in neuropsychological performance, but few reviews have examined whether cognitive performance is impaired among children and adolescents with primary headache disorders.</p><p><strong>Methods: </strong>we considered studies using a validated clinical neuropsychological measure among pediatric samples (<20-y old) that included a phd and control sample. two authors independently reviewed candidate articles to determine inclusion and to extract data. data were pooled using random-effects models. data sources: pubmed, embase, proquest health & medical, proquest psychology database, and psycinfo were searched from inception to february 2024.</p><p><strong>Results: </strong>Analysis of 16 included studies indicated significantly worse overall neuropsychological performance among pediatric PHD (g = -0.31; 95% CI = -0.44 to -0.17), as well as significantly worse performance across the motor, executive function, learning/memory, language, processing speed, intelligence, and visuospatial/construction domains, as compared with nonheadache controls. Moderate heterogeneity was observed (I2 = 43.13%) but analyses of publication bias and moderators were not significant. Sensitivity analyses indicated that negative effects were driven by samples with migraine and not observed among tension-type headache (TTH) samples.</p><p><strong>Conclusions: </strong>Relative to controls without headache, pediatric samples with migraine demonstrate worse neurocognitive performance both generally and across specific domains. A small number of studies among samples with TTH were included and moderator analyses were likely underpowered.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772767","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 Antibodies for Pediatric Viral Disease Prevention and Treatment.","authors":"Zeynep Bahadir, Priyanka Narayan, Rachael Wolters, Sallie R Permar, Genevieve Fouda, Ann J Hessell, Nancy L Haigwood","doi":"10.1542/peds.2024-068690","DOIUrl":"https://doi.org/10.1542/peds.2024-068690","url":null,"abstract":"<p><p>Medical advancements over the last century have improved our ability to treat pediatric infectious diseases, significantly reducing associated morbidity and mortality worldwide. Although vaccines have been pivotal in this progress, many viral pathogens still do not currently have effective vaccines. The COVID-19 pandemic highlighted the need for rapid responses to emerging viral pathogens and introduced new tools to combat them. This review addresses human monoclonal antibodies (mAbs) as a strategy for treating and preventing viral infections in pediatric populations. We discuss previously used and currently available mAbs and advancements in mAb discovery. We address the future of mAb therapy by describing novel approaches in drug production and delivery platforms in addition to alternative antibody classes. Finally, we review the challenges and limitations of mAb therapy development for newborns and children.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772752","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":"11-Year-Old Boy With B-ALL-Induced Hypereosinophilic Syndrome Presenting as Acute Encephalopathy.","authors":"Tristan Loveday, Cintia da Hora, Rudolph Wells, Lauren Chorny, Manisha Bansal, Scott Bradfield, Loren McLendon","doi":"10.1542/peds.2024-068064","DOIUrl":"https://doi.org/10.1542/peds.2024-068064","url":null,"abstract":"<p><p>Encephalopathy is a disturbance in neurologic function. It is commonly attributed to infectious and inflammatory etiologies but encompasses a wide differential. Hypereosinophilic syndrome (HES) is a rare cause of encephalopathy that is associated with underlying infection or malignancy. We present a pediatric patient who experienced several days of worsening encephalopathy and neurological deterioration associated with influenza B infection and hypereosinophilia. A thorough workup ultimately revealed a diagnosis of HES secondary to B cell acute lymphoblastic leukemia (B-ALL). This case exemplifies the importance of maintaining a broad approach to the diagnostic evaluation, treatment, and management of encephalopathy.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764616","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":"Adaptive Functioning Development in Infants with Agenesis of the Corpus Callosum.","authors":"Lauren D Haisley, Lana Hantzsch, Aaron R Glick, Jasmin Turner, Sooyeon Sung, Meghan R Swanson, Jason J Wolff, Catherine A Burrows, Kelly N Botteron, Stephen R Dager, Annette M Estes, Lisa Flake, Robert C McKinstry, Juhi Pandey, Robert T Schultz, Mark D Shen, Tanya St John, Lonnie Zwaigenbaum, Heather C Hazlett, Natasha Marrus, Elizabeth A Will, Jane E Roberts, Joseph Piven, Lynn K Paul, Jed T Elison","doi":"10.1542/peds.2024-066555","DOIUrl":"https://doi.org/10.1542/peds.2024-066555","url":null,"abstract":"<p><strong>Background and objectives: </strong>Agenesis of the corpus callosum (ACC) is a common congenital brain malformation. Early development in ACC remains unexamined, despite the increased likelihood for developmental delays and autistic behaviors. This study compares adaptive functioning in infants/toddlers with isolated ACC to children with other neurodevelopmental conditions and typical development.</p><p><strong>Methods: </strong>Parents of children with ACC completed the Vineland Adaptive Behavior Scale Interview at 6, 12, 18, and 24 months as part of a prospective longitudinal study. Comparison groups included children with fragile X, Down syndrome, high familial likelihood of autism spectrum disorder (both with and without autism spectrum diagnosis), and typical development (total n = 957; total assessments = 2676).</p><p><strong>Results: </strong>By 24 months, 29% of children with ACC were delayed in at least 1 domain. Linear mixed effect models showed significant group × time point interactions in all domains. Post-hoc comparisons revealed the ACC group had poorer performance in communication by 6, motor by 12, and daily living by 18 months but equivalent socialization compared with typically developing children; stronger skills across most domains and time points compared with genetic groups; and equivalent communication, stronger socialization, and weaker motor skills compared with the autism group.</p><p><strong>Conclusions: </strong>Although there is significant variability, on average, ACC compromises communication skills by 6 months, with reduced motor and daily living skills by 12 and 18 months, respectively. Multipronged intervention programs are needed for ACC beginning early in the first year of life, possibly leveraging early strengths in social skills.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764617","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":"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":"2025-04-01","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}