Pediatrics最新文献

{"title":"Utilization of Ambulatory Blood Pressure Monitoring in Children and Adolescents With Hypertension.","authors":"James T Nugent, David C Kaelber","doi":"10.1542/peds.2024-067463","DOIUrl":"10.1542/peds.2024-067463","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumothoraces Associated With Vaping Cannabis Concentrate.","authors":"Gabriella K Olgin, Catherine Ludwig, Michael A Matthay, Valerie Gribben","doi":"10.1542/peds.2024-067278","DOIUrl":"10.1542/peds.2024-067278","url":null,"abstract":"<p><p>Vaping-associated spontaneous pneumothorax (VASP) is a new diagnosis created to describe spontaneous pneumothorax associated with the use of vape devices. We describe a case of bilateral VASP in a previously healthy 15-year-old male who was vaping cannabis concentrate. This is the first case report of VASP involving the sole usage of cannabis concentrate. This patient reported vaping for only 6 months before initial presentation. As rates of vaping cannabis concentrate increase among adolescents, VASP should be considered in the differential diagnosis of chest pain in adolescents who vape nicotine or cannabis.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522595","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":"International Trends in Zinc Treatment for Diarrhea.","authors":"Omar Karlsson, Rockli Kim, S V Subramanian","doi":"10.1542/peds.2024-066701","DOIUrl":"10.1542/peds.2024-066701","url":null,"abstract":"<p><strong>Background: </strong>Diarrhea is a leading cause of death among children <5 years of age and can have long-term adverse consequences for human development. The World Health Organization has recommended the therapeutic use of zinc for the treatment of diarrhea, along with oral rehydration solutions, since 2004. We studied recent trends in the use of zinc to treat diarrhea in 23 low- and middle-income countries.</p><p><strong>Methods: </strong>A repeated cross-sectional design of 46 Demographic and Health Surveys from 23 countries was used to estimate the average annual change in zinc treatment across recent years. The earlier surveys were conducted in different years from 2009 to 2014, and the latest surveys were conducted in different years from 2015 to 2023, with an average gap of 6 years between surveys. A diarrhea episode during the 2 weeks before the survey and the treatment of diarrhea using zinc and oral rehydration solutions among children <5 years old was identified using an interview with mothers.</p><p><strong>Results: </strong>In the pooled sample, the treatment of diarrhea in children <5 years of age using zinc increased from 2% in the earlier surveys to 27% in the more recent surveys, or an average annual increase of 4 percentage points (pp). The prevalence of zinc treatment increased in all 23 countries, ranging from 9 pp per year on average in Sierra Leone to 1 pp in Cambodia.</p><p><strong>Conclusions: </strong>A large increase in the use of therapeutic zinc to treat diarrhea in children was observed in recent years. However, coverage remains incomplete.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546727","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":"Interventions to Reduce Imaging in Children With Minor Traumatic Head Injury: A Systematic Review.","authors":"Nick Lesyk, Scott W Kirkland, Cristina Villa-Roel, Sandra Campbell, Lynette D Krebs, Bill Sevcik, Nana Owusu Essel, Brian H Rowe","doi":"10.1542/peds.2024-066955","DOIUrl":"https://doi.org/10.1542/peds.2024-066955","url":null,"abstract":"<p><strong>Context: </strong>Reducing unnecessary imaging in emergency departments (EDs) for children with minor traumatic brain injuries (mTBIs) has been encouraged.</p><p><strong>Objective: </strong>Our objective was to systematically review the effectiveness of interventions to decrease imaging in this population.</p><p><strong>Data sources: </strong>Eight electronic databases and the gray literature were searched.</p><p><strong>Study selection: </strong>Comparative studies assessing ED interventions to reduce imaging in children with mTBIs were eligible.</p><p><strong>Data extraction: </strong>Two independent reviewers screened studies, completed a quality assessment, and extracted data. The median of relative risks with interquartile range (IQR) are reported. A multivariable metaregression identified predictors of relative change in imaging.</p><p><strong>Results: </strong>Twenty-eight studies were included, and most (79%) used before-after designs. The Pediatric Emergency Care Applied Research Network (PECARN) rule was the most common intervention (71%); most studies (75%) used multifaceted interventions (median components: 3; IQR: 1.75 to 4). Before-after studies assessing multi-faceted PECARN interventions reported decreased computed tomography (CT) head imaging (relative risk = 0.73; IQR: 0.60 to 0.89). Higher baseline imagine (P < .001) and additional intervention components (P = .008) were associated with larger imaging decreases.</p><p><strong>Limitations: </strong>The limitations of this study include the inconsistent reporting of important outcomes and that the results are based on non-randomized studies.</p><p><strong>Conclusions: </strong>Implementing interventions in EDs with high baseline CT ordering using complex interventions was more likely to reduce head imaging in children with mTBIs. Including the PECARN decision rule in the intervention strategy decreased orders by a median of 27%. Further research could provide insight into which specific factors influence successful implementation and sustained effects.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558470","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":"Increase in Cases of Perinatal HIV Transmission in Maryland in 2022.","authors":"David C Griffith, Matthew Grant, Wei Li Adeline Koay, Natella Rakhmanina, Anna Maya Powell, Allison Agwu","doi":"10.1542/peds.2023-065371","DOIUrl":"10.1542/peds.2023-065371","url":null,"abstract":"<p><p>The perinatal transmission of HIV is preventable through a regimen that includes testing of all pregnant individuals, antiretroviral treatment (ART) for the pregnant individual, prophylactic or preventative ART for the infant, and cesarean section delivery for mothers with HIV viremia at the time of delivery. Under this protocol, the United States has seen a significant decline in the perinatal transmission of HIV and achieved a perinatal HIV transmission rate of 0.9% in 2019. However, despite this progress nationally and after zero transmissions in 2021, Maryland recorded 6 cases of perinatal HIV diagnoses in 2022. Each of the 3 major referral centers for pediatric HIV patients in Maryland reported 2 new cases in 2022. A root cause analysis of the cases identified risk factors including delayed entry into perinatal and HIV care, premature birth, maternal adherence challenges in the setting of substance use and other adverse social determinants of health, and failure to diagnose maternal HIV infection in a timely way. All patients were successfully linked to care and initiated on ART. Multiple factors contributed to the 2022 increase in cases of perinatal HIV in Maryland. To achieve and then sustain the elimination of perinatal HIV transmission, the constancy of systems that eliminate barriers for all pregnant people to access testing, prevention, and treatment is critical.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392356","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":"Acknowledging Impact of Clothing Barriers on Disabled Children Experiencing Social Exclusion.","authors":"Chukwuma N Udezeh, Anne Kouri","doi":"10.1542/peds.2023-065159","DOIUrl":"10.1542/peds.2023-065159","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472347","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":"Affordable Care Act's Preventive Services Coverage Mandate and Receipt of Fluoride Varnish.","authors":"Ashley M Kranz, Yuji Mizushima, Andrew W Dick, Kimberley H Geissler, Tadeja Gracner","doi":"10.1542/peds.2024-066638","DOIUrl":"10.1542/peds.2024-066638","url":null,"abstract":"<p><p></p><p><strong>Background and objectives: </strong>The Affordable Care Act required private insurers to cover a set of recommended preventive services without cost-sharing. This included coverage of fluoride varnish (FV) applications without cost-sharing for children aged 1 through 5 during medical visits, an evidence-based treatment that prevents tooth decay. We examined if this coverage mandate was associated with more young children receiving FV.</p><p><strong>Methods: </strong>Using the Massachusetts All-Payer Claims Database (2014-2018), we examined the likelihood that a privately insured child received FV during a medical visit in a month. We used a difference-in-differences approach, comparing those included in the coverage mandate (aged 1-5) to those excluded from the mandate (aged 6-9), before and after the mandate was enacted (January 2015). We repeated analyses in children with Medicaid because this mandate may have had spillover effects for this population.</p><p><strong>Results: </strong>Among children aged 1 through 5 years with private insurance, 1-year postmandate the probability of FV receipt in a month increased 0.16 percentage points more relative to December 2014 (premandate) compared with the change among children aged 6 to 9 years (P < .001; 95% confidence interval = 0.1-0.22). When examining spillover to children with Medicaid, the mandate was not associated with a significant increase in the probability of monthly FV receipt 1-year postmandate.</p><p><strong>Conclusions: </strong>This Affordable Care Act mandate requiring coverage of FV without cost-sharing was associated with higher rates of young children receiving FV in medical settings, with the largest result observed among children with private insurance.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Disadvantage and Birth Outcomes Among Refugees.","authors":"Else Foverskov, Justin S White, Trine Frøslev, Lars Pedersen, Henrik T Sørensen, Rita Hamad","doi":"10.1542/peds.2024-065750","DOIUrl":"10.1542/peds.2024-065750","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment.</p><p><strong>Methods: </strong>This register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement.</p><p><strong>Results: </strong>Each SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations.</p><p><strong>Conclusions: </strong>Resettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mothers Falling Asleep During Infant Feeding.","authors":"Fern R Hauck, Rachel Y Moon, Stephen M Kerr, Michael J Corwin, Timothy Heeren, Eve Colson, Margaret G Parker, Ann Kellams","doi":"10.1542/peds.2024-066072","DOIUrl":"https://doi.org/10.1542/peds.2024-066072","url":null,"abstract":"<p><p></p><p><strong>Background and objectives: </strong>Falling asleep while feeding (FAF) infants is common. Our primary objectives were to examine (1) maternally reported prevalence of FAF and if planned; (2) association between FAF and sociodemographic factors, feeding method, and sleep location; and (3) if receipt of education about safe sleep and bedsharing risks was associated with FAF.</p><p><strong>Methods: </strong>In the Social Media and Risk-reduction Training study, US mothers of newborns were randomized to educational messaging promoting infant safe sleep or breastfeeding. We analyzed data from 1259 mothers who responded to the postpartum survey (mean infant age, 11.2 weeks). We used generalized estimating equation logistic regression models to examine the extent that sociodemographic characteristics, feeding type, usual nighttime feeding location, and intervention group were associated with FAF.</p><p><strong>Results: </strong>A total of 28.2% of mothers reported FAF usually or sometimes in the last 2 weeks, 83.4% of whom reported that FAF was unplanned. There were no differences in the odds of FAF by sociodemographic factors. Compared with mothers whose nighttime feeding location was their bed, mothers who reported feeding in a chair were less likely to FAF (33.6% versus 16.8%; adjusted odds ratio, 0.41; 95% confidence interval, 0.31-0.56). FAF was reported less frequently by mothers who received safe sleep interventions (15.6%), compared with mothers who received breastfeeding interventions (33.0%; adjusted odds ratio, 0.40; 95% confidence interval, 0.25-0.65).</p><p><strong>Conclusions: </strong>FAF is reported commonly among US mothers and is predominantly unplanned. Mothers who received safe sleep messaging were less likely to report FAF. New parents need guidance on planning for optimal safety during infant feeding.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558471","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":"ECMO Survivors' Reflections on Their ICU Experience and Recovery.","authors":"Elizabeth Hendrickson, Karan K Mirpuri, Amanda Kolmar","doi":"10.1542/peds.2024-067901","DOIUrl":"10.1542/peds.2024-067901","url":null,"abstract":"<p><strong>Objective: </strong>As pediatric mortality improves, approaches to pediatric critical care now focus on understanding long-term implications of survivorship on patients and families. We aimed to characterize how patients recall time spent sedated and recovering to identify areas for improvement in patient outcomes.</p><p><strong>Methods: </strong>We undertook qualitative analysis using semistructured interviews of pediatric patients requiring extra-corporeal support in our intensive care units from 2018 to 2023. All patients were English-speaking, >12 years old at time of hospitalization, and able to communicate at an age-appropriate level. Priority sampling was given to those with more recent hospitalizations to improve recall. Interviews were recorded and transcribed before thematic, inductive analysis.</p><p><strong>Results: </strong>Forty-one patients met inclusion criteria; 14 patients were enrolled before achieving thematic saturation. Several themes emerged, centering on cognitive, physical, and socioemotional experiences during and after hospitalization. Notable findings include profound awareness under sedation, impaired sleep, challenges with communication, physical discomfort, frustration with activities of daily living limitations, and gratitude for provider and family presence. Postdischarge, patients highlighted persistent memory, concentration, sleep, and physical impairments, as well as emotional processing of their illness and mortality.</p><p><strong>Conclusions: </strong>Our findings describe how pediatric critical illness impacts short and long term cognitive, physical, and socioemotional outcomes for children in the ICU. Future research is necessary to study if there are specific, modifiable factors in patients' care that impacts their experience of critical illness, such as specific medication choices, diagnoses, communication styles, or physical and speech therapy interventions.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}