Pediatrics最新文献

{"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}

{"title":"Urine Dipstick for the Diagnosis of Urinary Tract Infection in Febrile Infants Aged 2 to 6 Months.","authors":"Kathryn M Hunt, Rebecca S Green, Laura F Sartori, Paul L Aronson, James M Chamberlain, Todd A Florin, Kenneth A Michelson, Michael C Monuteaux, Pradip P Chaudhari, Lise E Nigrovic","doi":"10.1542/peds.2024-068671","DOIUrl":"10.1542/peds.2024-068671","url":null,"abstract":"<p><strong>Objective: </strong>Urine dipsticks can be performed at the point of care, whereas urinalysis requires laboratory analysis. We compared the accuracy of urine dipstick with urinalysis for the diagnosis of urinary tract infection (UTI) in febrile infants aged 2 to 6 months.</p><p><strong>Methods: </strong>We performed a cross-sectional study of previously healthy infants aged 2 to 6 months who presented to one of 5 emergency departments with a temperature greater than or equal to 38.0 °C and had a catheterized urine culture obtained. We defined a UTI with a urine culture growing greater than or equal to 50 000 colony-forming units (CFUs) per milliliter of a single bacterial uropathogen. Using receiver operator characteristic (ROC) curve analysis to select the optimal urine white blood cell (WBC) cut point, we compared positive urine dipstick (≥1+ leukocyte esterase or positive nitrite) to dichotomized urine WBC count for the diagnosis of UTI.</p><p><strong>Results: </strong>Of 9387 febrile infants who had a urine culture performed, 1044 (11%) had a UTI. Escherichia coli was the most common pathogen identified (923; 88.4%). The optimal urine WBC cut point was greater than or equal to 7 cells per high-power field (HPF). When compared with urine WBC count of greater than or equal to 7 cells per HPF, urine dipstick had a higher sensitivity (831/921 [90.2%] dipstick vs 738/880 [83.9%] urine WBC; difference 6.4%, 95% CI 3.8%-8.9%) and specificity (6352/6862 [92.6%] dipstick vs 3679/4231 [87.0%] urine WBC; difference 5.6%, 95% CI 4.7%-6.6%).</p><p><strong>Conclusion: </strong>Urine dipstick is an accurate diagnostic test for UTI in febrile infants aged 2 to 6 months. Laboratory urinalysis may not be required to guide initial treatment decisions.</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":"143692886","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":"Oopherectomy in a Child to Reduce Cancer Risk: Oncogenetic, Ethical, and Legal Considerations.","authors":"Jennifer Brewer, Georgia L Wiesner, Ellen W Clayton, Daniel J Benedetti","doi":"10.1542/peds.2024-068269","DOIUrl":"10.1542/peds.2024-068269","url":null,"abstract":"<p><p>In the following case, we will discuss the clinical, ethical, and legal intricacies associated with the management of a young child with a hereditary cancer predisposition syndrome. Patients with germline pathogenic variants in SMARCA4 are at an increased risk for development of small cell carcinoma of the ovary-hypercalcemic type, malignant rhabdoid tumors, and some lung cancers. This case highlights the complexity of a case wherein a mother is found to have this genetic syndrome, and further testing reveals her daughter to have the same pathogenic variant. Through this case, we explore the oncologic, genetic, legal, and ethical considerations at play when making an irreversible decision for a child that affects her current and future medical and reproductive capacities. To do so would mitigate the risk of future malignancy, adding a layer of legal and ethical complexity. Although each contributor individually concludes that surgery in this case should be delayed, this case demonstrates the need for an individualized approach that considers medical evidence, patient and family interests, and child welfare.</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":"143606075","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":"Orchestrating a Successful Veto Campaign Against a Detrimental School Immunization Bill.","authors":"Beth Bloom Emrick, Elizabeth A Copenhaver, Jennifer Gerlach, Jamie L Jeffrey, Andrea M Lauffer, Kathleen Martin, Youmna Mousattat, Lisa M Costello","doi":"10.1542/peds.2024-068983","DOIUrl":"10.1542/peds.2024-068983","url":null,"abstract":"<p><p>West Virginia has one of the most robust childhood school-entry immunization policies in the nation, allowing only medical exemptions. As of the 2024 state legislative session, the last reported case of measles in West Virginia was in 2009. For over a decade, multiple bills have been introduced to attempt to weaken the immunization policy. In 2024, the West Virginia Legislature passed House Bill (HB) 5105, which would allow private and parochial schools in West Virginia the option to opt out of state immunization requirements. This bill would threaten the well-being and lives of West Virginians by weakening herd immunity. In response, the West Virginia chapter of the American Academy of Pediatrics banded together with multiple stakeholders to coordinate a veto campaign for HB 5105 using media, petitions, phone calls, and in-person visits. Governor Jim Justice ultimately vetoed HB 5105. This case study highlights the importance of effective collaboration with stakeholders, engagement of medical organizations with shared goals, coordinated advocacy by health care professionals, and creating and implementing an effective public health message to maintain effective public health policy.</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":"143670599","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":"The Child Opportunity Index and Children's Health: A Meta-Analysis.","authors":"Jordan Tyris, Diane L Putnick, Susan Keller, Kavita Parikh, Edwina H Yeung","doi":"10.1542/peds.2024-067873","DOIUrl":"10.1542/peds.2024-067873","url":null,"abstract":"<p><p></p><p><strong>Context: </strong>Quantifying the impact of place on pediatric health is difficult given the diverse methodologies used to measure place-based social determinants. However, the Child Opportunity Index (COI) is increasingly used to study these relationships.</p><p><strong>Objective: </strong>To synthesize associations between the COI and pediatric health.</p><p><strong>Data sources: </strong>Fifteen databases, 4 gray literature sources, and diversitydatakids.org searched from 2014 to 2024.</p><p><strong>Study selection: </strong>US-based observational studies that evaluated children, the COI, and at least 1 pediatric health outcome.</p><p><strong>Data extraction: </strong>Protocol registered with PROSPERO (CRD42023418407). Random-effects models created pooled odds ratios (ORs) comparing very low/low COI to high/very high COI for mortality, emergency department (ED) use, and hospital use. Clinically relevant subgroups were explored.</p><p><strong>Results: </strong>Most studies (n = 61 of 85; 72%) reported inverse associations between the COI and an adverse outcome. Lower COI was associated with higher odds of mortality (OR, 1.50; 95% CI, 1.31-1.94; tau squared [τ2] = 0.045; 15 associations from 13 studies). Overall, ED visits were similar (OR, 1.38; 95% CI, 0.97-1.95; τ2 = 0.312; 10 associations from 6 studies), but the subgroup of all-cause ED visits were significantly higher among children with lower COI (OR, 1.66; 95% CI, 1.19-2.31; τ2 = 0.198; 7 associations from 5 studies). Select hospitalization subgroups (medical, surgical/trauma, and >30-day rehospitalizations) were significantly associated with COI, but not overall hospitalizations (OR, 1.15; 95% CI, 0.96-1.36; τ2 = 0.090; 12 studies).</p><p><strong>Limitations: </strong>Meta-analyses were unadjusted.</p><p><strong>Conclusions: </strong>Place is a risk factor for children's mortality and select measures of health care use. Shifting the focus from identifying place-based disparities to cocreating community-engaged strategies that mitigate disparities may effectively advance children's health equity.</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":"143701073","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":"COVID-19 Vaccination During Pregnancy and Major Structural Birth Defects.","authors":"Stacey L Rowe, Sheena G Sullivan, Flor M Muñoz, Matthew M Coates, Brianna Agnew, Onyebuchi A Arah, Annette K Regan","doi":"10.1542/peds.2024-069778","DOIUrl":"10.1542/peds.2024-069778","url":null,"abstract":"<p><p></p><p><strong>Background and objectives: </strong>COVID-19 vaccination is recommended during pregnancy; however, evidence on the prevalence of major structural birth defects born to people vaccinated early in pregnancy (≤20 weeks of gestation) is limited. We compared the prevalence of major structural birth defects by COVID-19 vaccination status and key strata: insurance provider, clinically diagnosed SARS-CoV-2 infection during pregnancy, and concomitant administration of other maternal vaccines. We also compared, head-to-head, the prevalence of birth defects by brand (Moderna mRNA-1273 vs Pfizer-BioNTech BNT162b2).</p><p><strong>Methods: </strong>A claims-based cohort study captured pregnancies ending in a live birth among people with an estimated last menstrual period between August 15, 2021, and December 24, 2021. Prevalence ratios comparing birth defects by exposure to COVID-19 vaccines were estimated using binomial regression with inverse probability treatment weights.</p><p><strong>Results: </strong>Among 78 052 pregnancies, we identified 1248 major structural birth defects (1049 [160.6 per 10 000 live births] among unvaccinated people and 199 [156.4 per 10 000 live births] among vaccinated people). No differences in the prevalence of major structural birth defects were observed given COVID-19 vaccination (adjusted prevalence ratio [aPR], 0.96; 95% CI, 0.81-1.13). Findings were unchanged by insurance provider, SARS-CoV-2 infection during pregnancy, and concomitant of other maternal vaccines. No differences in the prevalence of birth defects were observed among vaccinated people by brand (aPR, 1.02; 95% CI, 0.77-1.37).</p><p><strong>Conclusions: </strong>COVID-19 vaccination during early pregnancy is not associated with an increased prevalence of major structural birth defects in infants. These results support the safety of COVID-19 vaccination in early pregnancy.</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":"143625511","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":"GLP-1 Receptor Agonists in Pediatric and Adolescent Obesity.","authors":"Margaret A Stefater-Richards, Grace Jhe, Yanjia Jason Zhang","doi":"10.1542/peds.2024-068119","DOIUrl":"10.1542/peds.2024-068119","url":null,"abstract":"<p><p>Obesity remains highly prevalent among children in the United States and is associated with an ever-increasing burden of obesity-related diseases. Effective pediatric obesity prevention and treatment will require both societal interventions and health care system innovation. One recent advancement is the approval of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for use in adolescents. GLP-1RAs are notable for their effectiveness in weight management and in their ability to ameliorate obesity-related diseases. GLP-1RAs can be an important part of a comprehensive treatment plan for pediatric patients seeking obesity care, and we will review the pediatric clinician's considerations for their effective use. We discuss the history of obesity pharmacology and development of GLP-1RAs. We review the indications for use and common adverse reactions. We highlight the importance of mental health care for obesity treatment, with a focus on disordered eating behaviors and their intersection with obesity and pharmacologic treatment of obesity. Nutrition remains an important issue for obesity prevention and management, and we highlight nutritional concerns during GLP-1RA therapy. Finally, we discuss health inequities in obesity, the dangers of perpetuating these inequities if GLP-1RA access remains biased, and the opportunities for improvement.</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":"143542981","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":"Birth Prevalence of Gastroschisis in the United States: 2016-2022.","authors":"Jennifer M Schuh, Erwin Cabacungan, Amy J Wagner","doi":"10.1542/peds.2024-068696","DOIUrl":"10.1542/peds.2024-068696","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of gastroschisis has been increasing for decades globally across all ages and races/ethnicities and is one of few birth defects with rising prevalence in both developing and developed countries. However, there are some indications that rates in the United States may be declining. We aim to investigate national gastroschisis prevalence with 3 independent large-scale databases. We hypothesize that from 2016-2022, the data will congruently reveal a decline in gastroschisis prevalence in the United States.</p><p><strong>Methods: </strong>This study is a retrospective cross-sectional database review of 3 national datasets: 1 clinical outcomes-based dataset (the American College of Surgeons [ACS] National Surgical Quality Improvement Program-Pediatric [NSQIP-P] dataset), 1 administrative dataset (the Healthcare Cost and Utilization Project-National Inpatient Sample [HCUP-NIS]), and 1 public health-based dataset (the Center for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research [CDC WONDER]). Datasets were analyzed from 2016-2021/2022 for gastroschisis prevalence.</p><p><strong>Results: </strong>From 2016-2022, the ACS NSQIP-P dataset revealed a decline in gastroschisis frequency from 0.32 to 0.19 per 100 infants. The HCUP-NIS dataset demonstrated a decline from 3.32 to 2.46 per 10 000 births. CDC WONDER data revealed a decline from 2.43 to 1.60 per 10 000 births.</p><p><strong>Conclusion: </strong>From 2016-2022, 3 large-scale national datasets congruently reveal a decline in gastroschisis prevalence in the United States for the first time in decades. The cause is likely multifactorial and should be further investigated.</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":"143557672","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}