Pediatrics最新文献_第9页

Health Care Utilization and Neighborhood Violence: 2019-2023. 医疗保健利用与邻里暴力：2019-2023。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-13 DOI: 10.1542/peds.2025-071560

Oluwatobi Emmanuel Adegbile,Oladipo Kunle Afolayan,Nnenna Ann Ukoha,Kiana Rachele Johnson

{"title":"Health Care Utilization and Neighborhood Violence: 2019-2023.","authors":"Oluwatobi Emmanuel Adegbile,Oladipo Kunle Afolayan,Nnenna Ann Ukoha,Kiana Rachele Johnson","doi":"10.1542/peds.2025-071560","DOIUrl":"https://doi.org/10.1542/peds.2025-071560","url":null,"abstract":"BACKGROUND AND OBJECTIVESChildren experience the highest impact from neighborhood violence (NV) exposure. Timely access to care has proven to mitigate these untoward effects. However, robust, up-to-date information regarding patterns of health care access, including the impact of the COVID-19 pandemic among children exposed to NV, is lacking.METHODSWe used an annually collected nationally representative survey (National Health Interview Survey) to examine predictors of NV in 2019 to 2023. A residential parent or other adult knowledgeable about the child's health is selected to respond to questions about the child. We used a time series model to explore the impact of the COVID-19 pandemic on NV. We constructed logistic regression models to predict the patterns of health care access and use (preventive care access, acute care use, and unmet health needs) among children aged 2 to 17 years exposed to NV and adjusted for potential covariates.RESULTSOut of a sample of 29 013 representing a weighted population of 65 140 276 individuals, we found that 1676 children (weighted 3 735 352; 5.8% [95% CI, 5.5-6.2]) were exposed to NV from 2019 to 2023. The likelihood of exposure to NV increased significantly in 2022 compared with 2021. Exposure to NV is significantly associated with not having a routine dental examination, increased use of mental health services, increased acute care use, and delayed and forgone medical, dental, and mental health care due to cost.CONCLUSIONSAs challenges to prompt access to medical, dental, and mental health care persist among US children, exploring alternative strategies to pediatric health care financing is critical to robust childhood health care coverage.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439306","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}

引用次数: 0

Variation in Management of Children With Coccidioidomycosis. 儿童球孢子菌病治疗的差异。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-13 DOI: 10.1542/peds.2025-073730

Chiara Michienzie,John Galgiani,Sean P Fitzwater

{"title":"Variation in Management of Children With Coccidioidomycosis.","authors":"Chiara Michienzie,John Galgiani,Sean P Fitzwater","doi":"10.1542/peds.2025-073730","DOIUrl":"https://doi.org/10.1542/peds.2025-073730","url":null,"abstract":"OBJECTIVECoccidioidomycosis (CM) is not as well described in children as it is in adults. The Kaiser Permanente Southern California (KPSC) system provides care within an endemic region for CM, affording the opportunity to describe the diagnosis, management, and outcomes of CM in a large pediatric cohort.METHODSThis study is a retrospective manual medical record review of patients aged 17 years or younger with a new diagnosis of CM between January 1, 2015, and December 31, 2021. We extracted demographic characteristics, symptoms, diagnostic testing, and details of patient management.RESULTSCM was identified in 209 patients. The incidence was 3.3 cases per 100 000 children but varied within the area covered by KPSC. Common symptoms were fever, cough, and rash (>59% for each). Disseminated CM was present in 10 patients (4.8%). Of the 199 patients without disseminated infections, 57 were observed without antifungal treatment; 1 (1.2%) eventually required treatment. For the remaining 142 patients treated with antifungals, the median duration of treatment was 150 days (ranging from <3 months to >2 years). After stopping treatment, 3 (2.1%) had recurrence. Recurrence was identified primarily based on symptoms rather than serologic testing, and all responded well to treatment.CONCLUSIONSWide clinician variability in the management of pediatric coccidioidomycosis was observed. Recurrence after treatment or failure of observation without antifungals was rare. Results from serologic testing outside of the initial diagnosis in asymptomatic patients typically did not change clinical management, while symptomatic follow-up was important for management.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439305","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}

引用次数: 0

The 2025 David G. Nichols Health Equity Award Address: Leaning into Our Power to Achieve Health Equity for Children, Adolescents, and Young Adults. 2025年大卫·g·尼科尔斯健康公平奖演讲：利用我们的力量实现儿童、青少年和年轻人的健康公平。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-12 DOI: 10.1542/peds.2025-075442

Maria Trent

引用次数: 0

Ruxolitinib and Tocilizumab for Child Bronchiolitis Obliterans After Toxic Epidermal Necrolysis. Ruxolitinib和Tocilizumab治疗中毒性表皮坏死松解后儿童闭塞性细支气管炎。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-12 DOI: 10.1542/peds.2025-073162

Léa Jaume,Sophie Schmartz,Anne Welfringer-Morin,Christophe Delacourt,Maria Leite-de-Moraes,David Drummond,Christine Bodemer

引用次数: 0

Neurodevelopmental Outcomes of Isolated Cerebellar Pathologies in Extremely Preterm Infants. 极早产儿孤立小脑病变的神经发育结局。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-11 DOI: 10.1542/peds.2025-074603

Julia Buchmayer,Sophie Stummer,Renate Fuiko,Gregor Kasprian,Katrin Klebermaß-Schrehof,Angelika Berger,Katharina Goeral

{"title":"Neurodevelopmental Outcomes of Isolated Cerebellar Pathologies in Extremely Preterm Infants.","authors":"Julia Buchmayer,Sophie Stummer,Renate Fuiko,Gregor Kasprian,Katrin Klebermaß-Schrehof,Angelika Berger,Katharina Goeral","doi":"10.1542/peds.2025-074603","DOIUrl":"https://doi.org/10.1542/peds.2025-074603","url":null,"abstract":"BACKGROUND AND OBJECTIVESCerebellar pathologies, especially cerebellar hemorrhage (CBH), in extremely preterm infants has been increasingly detected through cerebral magnetic resonance imaging (cMRI). We evaluated prevalence, associated risk factors, and neurodevelopmental outcomes of isolated CBH in a contemporary cohort of high-risk infants without major supratentorial brain injuries.METHODSThis observational cohort study included infants born at less than 28 weeks' gestation during 2017-2022 who underwent cMRI at term-equivalent age. Cerebellar pathologies, including low-grade (≤3 mm) and high-grade (>3 mm) hemorrhages, cerebellar atrophy, and vermis hemorrhage, and their impact on outcomes at 2 years' corrected age were analyzed using multivariable regression adjusted for relevant neurodevelopmental covariates. Risk factors for CBH were also examined.RESULTSCBH was identified in 69 of 252 infants without major supratentorial injuries (27.4%; 74% low-grade and 26% high-grade injuries). At 2 years' corrected age, motor composite scores were significantly lower in the CBH group, including low-grade hemorrhage (≤3 mm). Larger hemorrhages and cerebellar atrophy were associated with poorer cognitive and motor performance. Vermian hemorrhages were linked to impaired motor development and higher rates of cerebral palsy. Infants with isolated CBH had lower gestational ages, birth weights, and 1-minute Apgar scores and higher rates of sepsis, patent ductus arteriosus requiring intervention, and high-grade retinopathy of prematurity.CONCLUSIONSExtremely preterm infants without supratentorial brain injury with CBH on cMRI demonstrated significantly impaired motor outcomes and higher rates of cerebral palsy at 2 years' corrected age. These findings highlight isolated CBH as an independent risk factor for neurodevelopmental impairment and for refining prognostication.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"6 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383706","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}

引用次数: 0

Addressing Disability Bias in Neuroprognostication. 解决神经预测中的残疾偏见。

IF 6.4 2区医学

Pediatrics Pub Date : 2026-03-11 DOI: 10.1542/peds.2025-074710

Grant L Lin, Sarah Jean Barton, Tyler Tate

引用次数: 0

Life After Death: Ethical Considerations of CPR in Brain-Dead Pediatric Organ Donors. 死后的生命：脑死亡儿童器官捐献者心肺复苏术的伦理考虑。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-10 DOI: 10.1542/peds.2025-072297

Jenny Kingsley,Miriam Piven Cotler,Brenda Barnum,Amy Shimada,Kailey Anber,Sabrina Derrington

{"title":"Life After Death: Ethical Considerations of CPR in Brain-Dead Pediatric Organ Donors.","authors":"Jenny Kingsley,Miriam Piven Cotler,Brenda Barnum,Amy Shimada,Kailey Anber,Sabrina Derrington","doi":"10.1542/peds.2025-072297","DOIUrl":"https://doi.org/10.1542/peds.2025-072297","url":null,"abstract":"The ethical considerations surrounding organ-preserving cardiopulmonary resuscitation (OP-CPR) in pediatric patients with brain death highlight tensions between preserving organ viability and respecting bodily integrity. This article explores these complexities through the case of JJ, a 12-year-old patient declared dead by neurological criteria, whose parents authorized organ donation. When JJ experienced cardiovascular collapse before organ procurement, the organ procurement organization's off-site director instructed hospital staff to perform OP-CPR, prompting ethical concerns from the pediatric intensive care unit (PICU) team. This Ethics Rounds article presents 3 perspectives on OP-CPR: (1) An ethicist working for an organ procurement organization asserts that OP-CPR aligns with the family's intent and the principle of justice by increasing organ availability; (2) 2 pediatric intensive care attendings and bioethicists argue OP-CPR may not be ethically justified due to the low likelihood of achieving the primary goal, potential harm to the donor's dignity and personhood, and concerns about poor communication and lack of explicit permission; and (3) 3 nurses reveal challenges related to communication, moral distress, and institutional policies that pertain to the practice of OP-CPR. The article underscores the need for clear guidelines, improved collaboration between PICU teams and organ procurement organizations, and ethical frameworks that address both conscientious objection and conscientious commitment in the context of OP-CPR.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381375","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}

引用次数: 0

Pediatric Mortality in Deployed United States Military Treatment Facilities: 2001-2022. 美国部署的军事治疗设施的儿童死亡率：2001-2022。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-10 DOI: 10.1542/peds.2025-071434

Sara E Bibbens,Jonathan D Stallings,Monica L Casmaer,Margaret M Shields,Michael J Clarion,Patrick W Hickey,Jennifer M Gurney

{"title":"Pediatric Mortality in Deployed United States Military Treatment Facilities: 2001-2022.","authors":"Sara E Bibbens,Jonathan D Stallings,Monica L Casmaer,Margaret M Shields,Michael J Clarion,Patrick W Hickey,Jennifer M Gurney","doi":"10.1542/peds.2025-071434","DOIUrl":"https://doi.org/10.1542/peds.2025-071434","url":null,"abstract":"OBJECTIVEPediatric mortality from conflict-related injuries exceeds that of adults. Understanding pediatric injury patterns and outcomes is critical for guiding resource allocation and training. This study characterizes pediatric injuries in conflict zones and examines relationships between injury patterns, resource allocation, and survival.METHODSA retrospective cohort analysis of the Department of Defense Trauma Registry from 2001 to 2022 was conducted for children younger than 18 years treated at deployed military treatment facilities in conflict zones with documented injuries and discharge status. The primary outcome was survival to hospital discharge.RESULTSA total of 5695 children met inclusion criteria with an overall mortality rate of 9.4%. Nonsurvivors had higher injury severity scores (25 vs 9, P < .001), were younger, and sustained burn injuries (18.1% vs 9.4%, P < .001). They experienced greater median [IQR] blood loss (12.1 [3.6, 24.8] mL/kg vs 2.9 [1.2, 8.3] mL/kg, P < .001) and required more transfusions (47.9% vs 29.4% P < .001). Neither group received balanced transfusion, with packed red blood cell-to-platelet ratios of 4:1 in nonsurvivors and 6.5:1 in survivors.CONCLUSIONThis large epidemiologic study highlights age-specific injury patterns and resuscitation needs contributing to pediatric mortality in conflict zones. Higher blood loss and resuscitation volumes in nonsurvivors underscore the need for early hemorrhage control. Findings support strategies that include standardized pediatric equipment and targeted training in early recognition and management of hemorrhagic shock with balanced transfusion. These results emphasize the need for tailored resources and protocols for pediatric patients in austere, conflict-related settings.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"63 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381374","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}

引用次数: 0

Family Navigation to Reduce Disparities in Early Intervention Services: A Randomized Controlled Trial. 家庭导航减少早期干预服务的差异：一项随机对照试验。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-09 DOI: 10.1542/peds.2025-070970

James P Guevara,Marsha Gerdes,Ellie Segan,Katherine Yun,Kate Wallis,Jeannette Newman,Roy Wade,Sara Molina-Robinson,Jungwon Min,Knashawn H Morales

{"title":"Family Navigation to Reduce Disparities in Early Intervention Services: A Randomized Controlled Trial.","authors":"James P Guevara,Marsha Gerdes,Ellie Segan,Katherine Yun,Kate Wallis,Jeannette Newman,Roy Wade,Sara Molina-Robinson,Jungwon Min,Knashawn H Morales","doi":"10.1542/peds.2025-070970","DOIUrl":"https://doi.org/10.1542/peds.2025-070970","url":null,"abstract":"OBJECTIVEDisparities in early intervention (EI) use are well documented. We sought to determine the effects of family navigation (FN) on EI services use and child development among low-income, racially diverse children with suspected developmental delays.METHODSWe conducted a randomized controlled trial at 6 pediatric practices in a large urban community. Children who were aged younger than 30 months, had a gestational age of more than 35 weeks, had parents who spoke English or Spanish, and were referred to Part C EI were eligible. Children were randomized to FN or usual care and followed for 12 months. The main outcome measures were multidisciplinary evaluation (MDE) and EI service initiation and duration obtained from county EI program administrative files and Bayley-3 developmental scores. We examined differences among groups using intention-to-treat logistic and Cox regression models.RESULTSWe randomized 358 eligible children and followed 305 (85%) for 12 months. Children were predominantly Black with family incomes of less than $55 000. Overall, 257 (72%) completed an MDE, and 195 (54%) initiated services. Children who received FN had greater odds of MDE completion (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) and greater EI service initiation (64.4% vs 54.7%; P = .02) than children who received usual care. The average duration of EI services and Bayley-3 scores did not differ among groups.CONCLUSIONSWe found that an FN program improved EI referral completion and services initiation but not EI duration or child development among a population of predominantly low-income urban Black children. Implementation of FN programs in similar minoritized communities may reduce disparities in access to EI services.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"40 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374180","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}

引用次数: 0

Supporting Family Engagement in Early Intervention. 支持家庭参与早期干预。

IF 8 2区医学

Pediatrics Pub Date : 2026-03-09 DOI: 10.1542/peds.2025-073470

Donald B Bailey

引用次数: 0