Pediatrics最新文献

{"title":"Retropharyngeal Abscess as a Cause of Bilateral Brachial Palsy in a Neonate.","authors":"Isabel Miras Aguilar,Gemma Villar Villar,Araceli Corredera Sánchez,Ariadna Sánchez Suárez,Rocío Castillo Miguel,María Medina Muñoz,Manuel Gómez Serrano,Eva Arias Vivas","doi":"10.1542/peds.2025-070883","DOIUrl":"https://doi.org/10.1542/peds.2025-070883","url":null,"abstract":"Neonatal brachial plexus palsy (NBPP) is caused by injury to the C5 to T1 nerve roots, which are responsible for both sensory and motor functions in the upper limbs. Importantly, NBPP is not always linked to delivery-related trauma. We present the case of a 16-day-old neonate who was evaluated in the emergency department for fever, lethargy, and skin pallor. In the context of an infection, the infant developed desaturation and a progressive loss of spontaneous mobility in the upper limbs, with the arms positioned in extension, adduction, and pronation. Suspecting an infectious complication in the upper cervical spine, an ultrasound was performed, followed by a computed tomography scan. The imaging revealed a retropharyngeal abscess that displaced the cervical spine and led to brachial paralysis. In this case, identifying the underlying cause of the paralysis enabled the prompt initiation of treatment, greatly improving the patient's neurological prognosis and chances of survival.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"106 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921016","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":"Case Finding for Celiac Disease With a Point-of-Care Test.","authors":"Caroline R Meijer-Boekel,Lucy Smit,M Elske van den Akker-van Marle,Leti van Bodegom,Floris van Overveld,Nan van Geloven,M Luisa Mearin","doi":"10.1542/peds.2024-067369","DOIUrl":"https://doi.org/10.1542/peds.2024-067369","url":null,"abstract":"BACKGROUND/OBJECTIVESCeliac disease (CD) is underdiagnosed and thus untreated in many cases. Untreated CD may be associated with severe health complications, increased morbidity and mortality, and considerable burdens to health care systems. Our objectives were to prospectively assess whether implementation of case finding in young children at the Dutch Preventive Youth Health Care Centers (YHCCs) is feasible and effective.METHODSFrom February 2019 to January 2022, parents of all children aged 1-4 years attending the YHCCs in the Kennemerland region were invited. If there was at least 1 CD-associated symptom, a point-of-care test was performed onsite to assess the (immunoglobulin [Ig] A/IgG/IgM) celiac autoantibodies against tissue transglutaminase type 2 (TGA). If positive, the child was referred for confirmation of the diagnosis if TGA-IgA was more than 7 times the upper limit of normal or if histopathology showed Marsh 2 or 3 in addition to positive autoantibodies against endomysium.RESULTSA total of 16 289 parents were invited for regular consultation, of whom 14 917 consented to fill in the questionnaire; 5301 (35.5%) reported symptoms. A total of 3203 tests were performed in 3103 children (58.5%; 47.8% female; median age 2.0 y) and was positive in 61 (1.9%). CD was confirmed in 56 children (1.7% [95% CI, 1.46-2.44]; median age 2.6 y). With the exception of abdominal distention (P = .036), symptoms were similarly frequent among children with and without CD. The overall crude incidence rate of CD diagnosed by case finding was 1.67 per 1000 person-years (95% CI, 1.27-2.15), significantly higher than by standard of care (0.14 per 1000 person-years; P < .001).CONCLUSIONCase finding for CD using a point-of-care test is effective and feasible at Dutch Preventive YHCCs. Implementation of case finding into the standard of care will lead to timely diagnosis of CD in childhood.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"24 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915104","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 Respite Homes: A Call to Action.","authors":"Amy S Porter,Jennifer M Snaman,Jonathan Cottor,Kim E Whitmore,Joanne Wolfe","doi":"10.1542/peds.2024-070217","DOIUrl":"https://doi.org/10.1542/peds.2024-070217","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"15 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915106","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 Respiratory Syncytial Virus Immunization Coverage in the Vaccine Safety Datalink: 2023-2024.","authors":"Stephanie A Irving,Bradley Crane,Eric S Weintraub,Suchita A Patel,Hilda Razzaghi,Matthew F Daley,Brian Dixon,James G Donahue,Candace C Fuller,Sharon Fuller,Darios Getahun,Sungching C Glenn,Simon J Hambidge,Lisa A Jackson,Karen B Jacobson,Elyse O Kharbanda,Judith C Maro,Sean T O'Leary,Teresa Schmidt,Katharine Sznajder,Nancy S Weinfield,Joshua T B Williams,Ousseny Zerbo,Allison L Naleway","doi":"10.1542/peds.2024-070240","DOIUrl":"https://doi.org/10.1542/peds.2024-070240","url":null,"abstract":"BACKGROUND AND OBJECTIVESIn 2023, the Advisory Committee on Immunization Practices recommended either Abrysvo, a vaccine administered during pregnancy, or nirsevimab, a monoclonal antibody administered to infants after birth, to protect infants from respiratory syncytial virus (RSV). Our objective was to assess the proportion of infants immunized against RSV through antenatal RSV vaccination or receipt of nirsevimab among linked pregnancy-infant dyads.METHODSUsing data from 10 Vaccine Safety Datalink health systems and a validated algorithm, we identified pregnant women aged 12 to 55 years with a live birth of 32 weeks' gestation or more from September 22, 2023, through March 31, 2024. We identified RSV vaccination using electronic health records supplemented with immunization information system (registry) data. Among infants from eligible pregnancies, we identified nirsevimab administered through March 31, 2024. We assessed infant RSV immunization, defined as exposure to antenatal RSV vaccination or receipt of nirsevimab, stratified by race and ethnicity, age, and birth month.RESULTSA total of 36 949 eligible infants were included from 43 722 pregnancies. Overall, 72% of infants were immunized against RSV; estimates were highest among infants born to non-Hispanic (NH) Asian mothers (84%). Disparities were identified by race, with 60% coverage among infants born to NH Black or NH Middle Eastern or North African mothers. Coverage was 59% to 78% by birth month, with nirsevimab more commonly administered to infants born earlier in the season.CONCLUSIONSIn this population of infants, 72% were immunized against RSV. Although overall coverage was high, disparities in immunization by race and ethnicity are a call to action.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914880","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":"Barriers to Administering Maternal RSV Vaccination and Monoclonal Antibodies.","authors":"Haya Hayek,Adam Gailani,Natasha B Halasa","doi":"10.1542/peds.2025-070649","DOIUrl":"https://doi.org/10.1542/peds.2025-070649","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"16 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914881","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":"Power Outages and Carbon Monoxide Poisoning in Children.","authors":"Alexander J Northrop, Vivian Do, Nina M Flores, Lauren Blair Wilner, Perry E Sheffield, Joan A Casey","doi":"10.1542/peds.2024-068213","DOIUrl":"https://doi.org/10.1542/peds.2024-068213","url":null,"abstract":"<p><p></p><p><strong>Introduction: </strong>Carbon monoxide (CO) is a colorless, odorless, and nonirritating gas that can result in health impacts ranging from mild headaches to death. Children are uniquely vulnerable to CO poisoning. Power outages may increase the risk of CO exposure through improper generator use.</p><p><strong>Methods: </strong>We used community-level power outage data from 2017 to 2020 and CO emergency department visits among children <18 from the Statewide Planning and Research Cooperative System (SPARCS) in New York State (NYS). We evaluated all-scale (≥1% of a community without power) and large-scale (≥20% of a community without power) outages and their impact on CO poisoning on the day of initial outage exposure and the 3 following days (lag day 0 through lag day 3) in a case-crossover study design.</p><p><strong>Results: </strong>We identified 917 cases of CO poisoning and an incidence rate of 5.6 per 100 000 person-years in NYS from 2017 to 2020. The incidence rate of CO poisoning was highest among children aged 5 years or younger (7.8 per 100 0000 person-years) and among Black children (9.1 per 100 000 person-years). Four hours without power increased the odds of a pediatric CO poisoning ED visit on the day of exposure by ≥50% for all-scale and ≥150% for large-scale outages. Associations were stronger in urban vs rural areas.</p><p><strong>Conclusion: </strong>Although CO poisoning is a rare cause of pediatric ED visits in NYS, it is preventable. Outages substantially increased the odds of CO poisoning-related ED visits among children and should be regarded as an important CO poisoning risk factor.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064361","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":"Medicaid's Critical Role in Protecting Children and Young Adults With Chronic Health Conditions.","authors":"Alon Peltz,Kristin Kan","doi":"10.1542/peds.2025-070863","DOIUrl":"https://doi.org/10.1542/peds.2025-070863","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"109 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903055","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":"Changes in Chronic Medication Dispensing to Children and Young Adults During Medicaid Unwinding.","authors":"Kao-Ping Chua,Joanne Constantin,Genevieve M Kenney,Rena M Conti,Kosali Simon","doi":"10.1542/peds.2024-070380","DOIUrl":"https://doi.org/10.1542/peds.2024-070380","url":null,"abstract":"BACKGROUND AND OBJECTIVESMedicaid eligibility determinations paused during the COVID-19 pandemic but resumed in April 2023. We evaluated whether this \"Medicaid unwinding\" disrupted chronic medication therapy in young patients.METHODSThis study was a difference-in-differences analysis of the 2017-2023 IQVIA Longitudinal Prescription Database (92% of US pharmacies). Analyses included Medicaid-insured children aged 0 to 18 years and young adults aged 19 to 25 years using 5 chronic medication classes during quarter 1 of 2017 to 2023: attention-deficit/hyperactivity disorder medications, antidepressants, antiepileptics, antipsychotics, and inhaled steroids. Outcomes included the number of days with active prescriptions, having no prescriptions, and having 1 or more cash-pay prescriptions in quarters 3 and 4 of 2017 to 2023. Changes between 2017 to 2022 and 2023 were compared among states in the top vs bottom quartile of the percent reduction in Medicaid enrollment through December 2023. Analyses were conducted separately by age group and medication class.RESULTSSample sizes ranged between 226 311 and 4 683 451 person-years. Among children, residence in a state experiencing high Medicaid enrollment loss was associated with a greater decrease in the number of days with active prescriptions for 1 class and a greater increase in the risk of having 1 or more cash-pay prescriptions for 3 classes. Among young adults, residence in such a state was associated with a greater decrease in the number of days with active prescriptions for 2 classes and with a greater increase in the risk of having no prescriptions and 1 or more cash-pay prescriptions for all classes.CONCLUSIONS AND POLICY IMPLICATIONSMedicaid unwinding disrupted chronic medication therapy in young patients, particularly young adults. To reverse these disruptions, policymakers could help disenrolled patients find alternative coverage.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"10 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903057","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 Timely Diagnosis of Arterial Ischemic Stroke at a Pediatric Emergency Department.","authors":"Theodore E Trigylidas,Nichole L McCollum,Kathleen M Brown,Joshua C Heffren,Elizabeth M Wells,Paola Pergami,Jonathan Murnick,Deborah LaViolette,Dana B Harrar","doi":"10.1542/peds.2024-067166","DOIUrl":"https://doi.org/10.1542/peds.2024-067166","url":null,"abstract":"BACKGROUND AND OBJECTIVESPediatric arterial ischemic stroke (AIS) is an important cause of morbidity and mortality that requires early recognition to benefit from hyperacute therapies. We sought to improve timely diagnosis of AIS through an interdisciplinary stroke response protocol.METHODSA quality improvement initiative was implemented at our pediatric hospital emergency department from November 2019 to June 2023. We introduced a series of Plan-Do-Study-Act cycles that included educational initiatives (October 2021), the development of a stroke alert paging system to key stakeholders (November 2021), and stroke order set modifications (April 2022). All patients aged 0 to 21 years with clinical concern for AIS that had neuroimaging performed in the emergency department met criteria for inclusion in analysis. Our outcome measure was improvement of median door-to-imaging time for children with suspected AIS. Median door-to-imaging times for patients with confirmed stroke on imaging were also measured. Statistical process control charts were used to monitor data over time.RESULTSA total of 71 patients met criteria for inclusion in analysis during our study period. Four patients had confirmed AIS on neuroimaging. Median door-to-imaging time improved from 128 minutes to 68 minutes after intervention. Times improved from 113 minutes to 68 minutes for patients with confirmed stroke.CONCLUSIONStroke alert teams may be beneficial for coordination of care and support in ensuring a higher proportion of children with clinical concern for AIS receive expedited neuroimaging.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"54 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903056","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":"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":"2025-05-01","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}