Pediatrics最新文献

{"title":"Unilateral Leg Swelling and Liver Enzyme Elevation in an Adolescent.","authors":"Gabrielle Horner, Grace Luger, Mary McGrath, Anita Sharma, David A Bloom, Victoria Shakhin","doi":"10.1542/peds.2024-067246","DOIUrl":"https://doi.org/10.1542/peds.2024-067246","url":null,"abstract":"<p><p>A previously healthy 15-year-old female developed sudden onset right lower extremity swelling, pain, and erythematous linear streaking from the ankle to mid-thigh. Duplex venous ultrasound revealed multiple superficial and deep venous thrombi in the right lower extremity. Incidentally, the patient was also noted to have elevated transaminases and a microcytic anemia with significant iron deficiency. Additional evaluation ultimately led to the diagnosis of 2 distinct but interconnected chronic conditions, one of which progressed to requiring liver transplantation.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449265","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":"Factors Associated With Delay to Care in Pediatric and Adolescent Adnexal Torsion.","authors":"Barrie S Rich, Bailey Roberts, Colleen Nofi, Richard D Glick, Jason C Fisher, Emily Durkin, Romeo Ignacio, Carlos Garcia, Abigail Alexander, Scott Short, Derek Krinock, Lindsey L Wolf, Richard Weiss, Emma Ryan, Daniel J Robertson, Emmanuel Abebrese, Kyle J Van Arendonk, Rosa Hwang, Gary Nace, Jane Cerise, David H Rothstein","doi":"10.1542/peds.2024-068204","DOIUrl":"https://doi.org/10.1542/peds.2024-068204","url":null,"abstract":"<p><strong>Background and objectives: </strong>Diagnosis of adnexal torsion is challenging due to variable clinical presentations and often inconclusive imaging results. We hypothesized that diagnostic delays are common, leading to prolonged ischemia and subsequent tissue loss. We aimed to identify factors associated with diagnostic delays in pediatric patients with adnexal torsion.</p><p><strong>Methods: </strong>We performed a multi-institutional retrospective review of females aged 5 to 18 years with confirmed adnexal torsion between 2013 to 2022. Delay to care was defined as prior emergency department discharge within 7 days of operation and/or hospital admission without initial plan for operation.</p><p><strong>Results: </strong>862 patients were identified from 10 children's hospitals, with delayed diagnosis in 30%. Patients with delay were less likely to present with emesis or fever, have initial pediatric surgery consultation, or have typical ultrasound findings of torsion compared to those without delay (P < .05). For every unit increase in area deprivation index, the odds of delay increased by 1.3% (odds ratio 1.013, 95% CI, 1.007-1.018). The odds of delay were 81% greater for patients living > 30 miles from the hospital compared with 1-10 miles (odds ratio 1.812, 95% CI, 1.236-2.657). Oophorectomy and salpingectomy rates were 10% and 13%; those with delay had higher risk of oophorectomy (14% vs 7%, P = .002).</p><p><strong>Conclusion: </strong>Delayed diagnosis of adnexal torsion is common and associated with higher area deprivation index and farther distance from hospital. Risk of oophorectomy was higher in patients with delay. Improved diagnostics and increased awareness of social disparities are critical to decrease time to definitive treatment and improve rates of adnexal salvage.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449074","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":"Guidance for the Primary Care Provider in Identifying Infants With Biliary Atresia by 2-4 Weeks of Life: Clinical Report.","authors":"Sanjiv Harpavat, Susan W Aucott, Saul J Karpen, Benjamin L Shneider, Kasper Wang","doi":"10.1542/peds.2024-070077","DOIUrl":"https://doi.org/10.1542/peds.2024-070077","url":null,"abstract":"<p><p>This report helps pediatric primary care providers quickly identify infants with biliary atresia, which has the potential to improve outcomes and reduce need for liver transplant. The strategy is intended to be used between 2 and 4 weeks of life at the \"By 1 month\" well-child visit in the Bright Futures/American Academy of Pediatrics \"Recommendations for Preventive Pediatric Health Care.\" The strategy involves examining every infant's eye color, stool color, and prior laboratory results to determine whether measurement of a direct or conjugated bilirubin level is warranted.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441288","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 Concerning Is a Single Bruise for Child Physical Abuse?","authors":"Tagrid M Ruiz-Maldonado, Suzanne B Haney","doi":"10.1542/peds.2024-069360","DOIUrl":"https://doi.org/10.1542/peds.2024-069360","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441318","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":"Single Bruise Characteristics Associated With Abusive vs Accidental Injury.","authors":"Audrey Raut, Mary Clyde Pierce, Kim Kaczor, Doug Lorenz, Gina Bertocci, Karen Bertocci, Kirsten Simonton","doi":"10.1542/peds.2024-067932","DOIUrl":"https://doi.org/10.1542/peds.2024-067932","url":null,"abstract":"<p><p></p><p><strong>Objectives: </strong>The TEN-4-FACESp bruising clinical decision rule (BCDR) is a validated screening tool utilizing information about a child's body region bruised, age, and pattern of bruising to predict abuse in children younger than 4 years of age. Our objectives were to (1) evaluate the accuracy of the BCDR in predicting abuse when only 1 bruise was present and (2) identify other characteristics differentiating abusive from accidental injury in young children with a single bruise.</p><p><strong>Methods: </strong>Patients included in this secondary analysis were those from the BCDR validation study whose only skin finding was a single bruise (including petechiae, subconjunctival hemorrhage, or frenulum injury). Cases were previously classified as abuse, accident, or indeterminate by an expert panel. We compared demographics, clinical characteristics, bruising regions, and psychosocial risk factors (PRFs) between abuse and accident groups.</p><p><strong>Results: </strong>Of 349 patients with a single bruise, 27 were classified as abuse. The TEN-4-FACESp BCDR performed with 81.5% sensitivity and 87.6% specificity in this sample. Patients with abusive injuries were (1) younger and (2) less likely to present with an injury complaint but more likely to (3) have a bruise in a BCDR-positive region, (4) have a lower Glasgow Coma Score, and (5) have PRFs.</p><p><strong>Conclusions: </strong>The TEN-4-FACESp BCDR is an effective screening tool for abuse among young children with a single bruise in the pediatric ED. Even 1 BCDR-positive bruise indicated increased risk for abuse. Negative BCDR results must be interpreted with caution given the higher rate of false negatives in this analysis compared with the validation study.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441334","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":"Parent Perspectives on Health Care-Based Voter Engagement: A Qualitative Study.","authors":"Margaret N Jones, Tessa N Doan, Lauren Lipps, Tierra Dennis, Talia Ruxin, Sarah J Kopp, Victoria Liu, Saishravan Shyamsundar, Andrew F Beck, Hilary Izatt, James A McCann, Wylie D C Chang, Laura Sandoval, Saige Camara, Kristen A Copeland","doi":"10.1542/peds.2024-068207","DOIUrl":"https://doi.org/10.1542/peds.2024-068207","url":null,"abstract":"<p><strong>Objectives: </strong>To determine parent perspectives on (1) the connection between voting and child health and (2) the best ways for clinicians to promote voter engagement among patients and their families.</p><p><strong>Methods: </strong>Qualitative study with semistructured interviews. Parents or guardians of all patients of academic pediatric primary care offices at a large, urban children's hospital in the Midwestern United States were invited to participate by email. Participants completed demographic and voting habits surveys. Trained coders independently analyzed transcripts using iterative, thematic, inductive open coding.</p><p><strong>Results: </strong>We conducted 22 interviews. Most participants were female (91%), Black (55%), and non-Hispanic (95%). Participants represented a variety of education levels, political perspectives, and degrees of civic participation. Themes on the connection between voting and child health included the following: (1) voting helps \"make your community a better place\" for children now and in the future; (2) voting impacts funding for services that affect child health; and (3) voting influences our social environment, which in turn impacts child health. Themes on recommendations for health care-based voter engagement included the following: (4) consider context about voting messaging (eg, provide context about connection with health); (5) provide a variety of communication media options for delivering voting information; and (6) include a variety of health care staff in delivering voting messages.</p><p><strong>Conclusions: </strong>In this qualitative study, we captured parent perspectives on the connection between voting and child health and desired methods for health care-based voter engagement. Our findings can inform future hypotheses for testing the mechanisms underlying established connections between voting and child health outcomes.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414897","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":"Atraumatic Subdural Hematoma in a Patient on Adalimumab.","authors":"Anthony V Nguyen, Bronson M Ciavarra, Muralidhar Jatla, Eric R Trumble","doi":"10.1542/peds.2024-069969","DOIUrl":"https://doi.org/10.1542/peds.2024-069969","url":null,"abstract":"<p><p>An atraumatic subdural hematoma (SDH) in a pediatric patient is a rare clinical entity. Although the United States Food and Drug Administration lists SDH as a possible adverse effect of adalimumab therapy for rheumatoid arthritis, the literature lacks reports of SDH in patients on adalimumab. A boy aged 16 years old with a history of ulcerative colitis on adalimumab presented with headache and a right pronator drift. Imaging demonstrated a 2.4-cm SDH on the left with 1.4 cm of midline shift. The patient underwent craniotomy and SDH evacuation, which revealed chronic SDH fluid and subdural membranes. Imaging and culture results did not suggest any other etiology (trauma, vascular malformations, infectious etiologies, or posterior reversible encephalopathy syndrome). The patient was transitioned from adalimumab therapy to ustekinumab therapy and did well without any recurrence.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414896","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":"Infanticide and Infant Abandonment: New Directions in US Law and Policy.","authors":"Lori Bruce, Clara S Lewis, Mark R Mercurio","doi":"10.1542/peds.2024-068991","DOIUrl":"https://doi.org/10.1542/peds.2024-068991","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"155 3","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414899","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 Mental Health Boarding: 2017 to 2023.","authors":"Kathleen D Snow, Jonathan M Mansbach, Christopher Cortina, Jay G Berry, Amanda S Growdon, Patricia A Stoeck, Kathleen Walsh","doi":"10.1542/peds.2024-068283","DOIUrl":"https://doi.org/10.1542/peds.2024-068283","url":null,"abstract":"<p><p></p><p><strong>Background and objectives: </strong>Boarding for pediatric mental health (MH) conditions is common at US children's hospitals while patients await care at a psychiatric facility. We sought to describe recent trends in boarding encounters and to identify factors associated with prolonged length of stay.</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional study analyzing pediatric MH boarding encounters at 40 tertiary children's hospitals included in the Pediatric Health Information System database between January 1, 2017, and December 31, 2023. Children ages 3 to 18 presenting with a primary psychiatric diagnosis were included in the analysis. We assessed trends in boarding encounters and length of stay over time and analyzed variations in boarding practices among hospitals. Risk factors for prolonged boarding (≥9 days) were identified using mixed effects logistic regression models.</p><p><strong>Results: </strong>Between 2017 and 2023, there were 100 784 boarding encounters across 40 hospitals. Median length of stay for boarding encounters increased from 3 to 4 days (P < .001) and 350 (0.3%) children had stays of longer than 100 days. Boarding practices varied significantly by hospital site. Factors associated with prolonged boarding included older age, government insurance type, increasing medical complexity, specific psychiatric disorder, season of presentation, and discharge disposition to home.</p><p><strong>Conclusions: </strong>Boarding while awaiting acute psychiatric care remains common, with a sustained increase in the volume of boarding encounters and length of stay since the onset of the COVID-19 pandemic. Patients with medical and/or psychiatric complexity may be more likely to experience prolonged boarding, highlighting an area for improved access to care.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409625","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":"Missed Opportunities to Address SNAP for Nonenrolled Children.","authors":"Alexandra T Geanacopoulos, Claire E Branley, Arvin Garg, Margaret E Samuels-Kalow, Jonathan M Gabbay, Alon Peltz","doi":"10.1542/peds.2024-066652","DOIUrl":"10.1542/peds.2024-066652","url":null,"abstract":"<p><p></p><p><strong>Background: </strong>Primary care is an important setting to identify and support children who are eligible but not enrolled in the Supplemental Nutrition Assistance Program (SNAP) (the SNAP Gap), although there is concern that these programs may be limited in reach. We sought to identify patterns of health care use among eligible but unenrolled children.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of the 2021 Medical Expenditure Panel Survey. We identified 975 SNAP eligible/nonenrolled children with household incomes less than 200% of federal poverty level. SNAP eligibility was modeled using income, employment, and household composition and SNAP enrollment was self-reported. We categorized health care encounters across 9 visit types and calculated annual primary care attendance rates. Multivariable logistic regression was used to measure associations with race, language, and chronic conditions.</p><p><strong>Results: </strong>SNAP eligible/nonenrolled children received an average of 6.04 health care encounters in 2021. Only half (52.9%) received a primary care visit. Primary care attendance was lowest for Black children (odds ratio [OR] = 0.40 [95% CI 0.20-0.81], P = .01), children speaking languages other than English (OR = 0.53 [95% CI 0.32-0.89], P = .02) and children without a chronic condition (OR = 0.08 [95% CI 0.04-0.15], P < .001). Visits to medical specialists (20.4% of all visits), behavioral health clinicians (10.9%), and dentists (10.0%) were the most common nonprimary care services received by SNAP eligible/nonenrolled children.</p><p><strong>Conclusion: </strong>In a nationally representative sample of children who were potentially eligible but nonenrolled in SNAP, we found low primary care attendance in 2021 with evidence of racial and linguistic disparities. Clinicians beyond the primary care system are well-positioned to support children who jointly underuse government nutrition programs and primary care services.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409610","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}