Pediatrics最新文献

{"title":"2025 Recommendations for Preventive Pediatric Health Care: Policy Statement.","authors":"","doi":"10.1542/peds.2025-071066","DOIUrl":"10.1542/peds.2025-071066","url":null,"abstract":"","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":"143365308","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":"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":"2025-05-01","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":"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":"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":"2025-05-01","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":"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":"10.1542/peds.2024-069598","url":null,"abstract":"","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":"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":"Graduating Residents' Readiness for Unsupervised Practice.","authors":"Daniel J Schumacher, Catherine Michelson, Ariel Winn, Duncan Henry, Meghan O'Connor, Su-Ting T Li, Robyn J Blair, Maria Velazquez-Campbell, Margaret J Kihlstrom, Emily Borman-Shoap, Keith Ponitz, Joselyn Salvador-Sison, Benjamin Kinnear, David A Turner, Abigail Martini, Heather L Burrows, Rita Patel, Lauren M Newhall, Rachel Osborn, Mia Mallory, Johannah M Scheurer, Matthew Grant, Ross E Myers, Elena C Griego, Svetlana Kravtchenko, Shivika Jain, Thao Vu, Alan Schwartz","doi":"10.1542/peds.2024-070307","DOIUrl":"10.1542/peds.2024-070307","url":null,"abstract":"<p><p></p><p><strong>Objective: </strong>This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).</p><p><strong>Methods: </strong>At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.</p><p><strong>Results: </strong>Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P < .001).</p><p><strong>Conclusion: </strong>While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation.</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":"143811986","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":"How to Build a Better Doctor.","authors":"Hilary M Haftel","doi":"10.1542/peds.2025-070654","DOIUrl":"10.1542/peds.2025-070654","url":null,"abstract":"","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":"143811989","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":"Reconsidering the Diagnosis of Conduct Disorder to Reduce Discrimination.","authors":"CheyAnne Olivia Rivera","doi":"10.1542/peds.2024-069880","DOIUrl":"https://doi.org/10.1542/peds.2024-069880","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"109 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902991","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":"Cost-Effectiveness Analysis of Undesignated Stock Epinephrine for Anaphylaxis in US Summer Camps.","authors":"Carissa Bunke,Natalie Schellpfeffer,Harvey Leo,Andrew Hashikawa,Kenneth J Smith,Barry Garst,Tracey Gaslin,Kathleen A Noorbakhsh","doi":"10.1542/peds.2024-068960","DOIUrl":"https://doi.org/10.1542/peds.2024-068960","url":null,"abstract":"BACKGROUNDAnaphylaxis is life-threatening and requires immediate treatment with injectable epinephrine. Among the 20 million children attending US summer camps yearly, 2.5% (approximately 500 000) have immunoglobulin E (IgE)-mediated food allergies and fewer than half bring their epinephrine to camp.OBJECTIVEWe aimed to investigate the cost-effectiveness of stock epinephrine in US summer camps.METHODSUsing a decision-analytic Markov model, the outcomes of pediatric anaphylaxis were simulated using 4 strategies: (1) individual-provided epinephrine, (2) stock epinephrine, (3) current practice, and (4) stock epinephrine plus individual epinephrine. Secondary analyses included cost per hospitalization avoided and cost-effectiveness of nurse-drawn epinephrine solution and, in a 3-year model, intranasal epinephrine instead of autoinjectors.RESULTSStock epinephrine was the least expensive and most effective ($4.33, 69.9 quality-adjusted life-days [QALDs]) strategy. The model was sensitive to the quantity of campers with IgE-mediated food allergy. In camps in which stock epinephrine was infeasible, individual-provided epinephrine was preferred. In 1-way sensitivity analyses, results were sensitive to epinephrine cost, IgE-mediated food allergy and anaphylaxis risks, hospitalization risk, and the number of weekly campers. Secondary analyses demonstrated that the individual-provided epinephrine strategy resulted in the most hospitalizations; stock epinephrine plus individual epinephrine cost $9476 per hospitalization avoided. Stock epinephrine plus individual epinephrine was the preferred strategy for nurse-drawn epinephrine solution ($8.72, 69.9 QALDs) and intranasal epinephrine ($27.07, 209.9 QALDs, 3 camp seasons).CONCLUSIONSA strategy of stock epinephrine autoinjectors alone was the most cost-effective in our model. A strategy of stock epinephrine plus individual epinephrine became more economically feasible when epinephrine costs were lower or IgE-mediated food allergy risk was higher.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902990","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":"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":"2025-05-01","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":"A Callout for Obesity Prevention Trials in Early Childhood.","authors":"Richard E Boles, Ihuoma Eneli","doi":"10.1542/peds.2024-070331","DOIUrl":"10.1542/peds.2024-070331","url":null,"abstract":"","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":"143754084","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}