Pediatrics最新文献_第9页

Improving Delayed Cord Clamping Across Tennessee Through a Statewide Quality Collaborative. 通过全州质量协作改善田纳西州的延迟脐带夹紧。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-15 DOI: 10.1542/peds.2024-066158

Scott O Guthrie,Howard E Herrell,Patricia A Scott,Bonnie J Miller,Sharon Wadley,Brenda Barker

{"title":"Improving Delayed Cord Clamping Across Tennessee Through a Statewide Quality Collaborative.","authors":"Scott O Guthrie,Howard E Herrell,Patricia A Scott,Bonnie J Miller,Sharon Wadley,Brenda Barker","doi":"10.1542/peds.2024-066158","DOIUrl":"https://doi.org/10.1542/peds.2024-066158","url":null,"abstract":"OBJECTIVEThe objective of this initiative was to increase the proportion of infants born in participating hospitals receiving the benefits of delayed cord clamping (DCC) for at least 60 seconds to a minimum of 90% for each facility.METHODSIn January 2022, a quality improvement (QI) initiative was launched across 5 pilot hospitals, later expanding to 22 additional hospitals in May 2022. The goal of the initiative was to ensure that all newborns at each facility experienced a delay of at least 60 seconds before umbilical cord clamping. Monthly data collection continued through June 2023, tracking the number of live births, the number of infants whose cords were clamped after 60 seconds, and race/ethnicity. Balancing measures, including the number of infants with a 5-minute appearance, pulse, grimace, activity, and respiration (Apgar) score of up to 3 and hypothermia (temperature of <36.5 °C), were recorded monthly. Structure and process measures critical for improving DCC rates were also identified and monitored.RESULTSAt project completion, 61 642 out of 74 241 (83%) infants received a delay of at least 60 seconds in cord clamping. The aggregate baseline mean for DCC was 76%. Special cause variation (a favorable shift) was observed, resulting in an adjusted mean rate of 87% for DCC. The impact was consistent across both level I/II and level III/IV facilities.CONCLUSIONSThis report highlights the successful implementation of DCC practices through the state's perinatal QI collaborative. Evidence-based QI initiatives can significantly enhance uptake of recommended practices and improve infant care during birth.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"16 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836533","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

Development and Evaluation of an Advocacy Curriculum for Pediatric Emergency Medicine Fellows. 儿科急诊医学研究员宣传课程的开发与评估。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-15 DOI: 10.1542/peds.2024-067564

Megan M Attridge,Kristen M Kester,Samaa Kemal,Selina Varma Thomas,Karen Mangold,Jennifer A Hoffmann

{"title":"Development and Evaluation of an Advocacy Curriculum for Pediatric Emergency Medicine Fellows.","authors":"Megan M Attridge,Kristen M Kester,Samaa Kemal,Selina Varma Thomas,Karen Mangold,Jennifer A Hoffmann","doi":"10.1542/peds.2024-067564","DOIUrl":"https://doi.org/10.1542/peds.2024-067564","url":null,"abstract":"Advocacy is a key skill for pediatric emergency medicine (PEM) physicians; however, advocacy education is not a PEM fellowship program requirement, and literature describing the design, implementation, or evaluation of PEM advocacy curricula have not been published. We aimed to develop, implement, and evaluate a curriculum to teach core advocacy concepts to PEM fellows that builds on advocacy training in residency. An advocacy curriculum for PEM fellows, informed by a needs assessment, was implemented at an urban academic children's hospital during the 2021 to 2022 academic year. Eight fellows participated in the curriculum, which consisted of didactic and work group sessions integrated into the fellows' educational conference. PEM fellows were surveyed before and after 1 year of curriculum participation to assess advocacy attitudes, knowledge, skills, and participation in advocacy activities. After the curriculum, most fellows agreed or strongly agreed they had the skills to conduct specific advocacy activities, and fellows reported participating in a range of advocacy activities including use of social media for advocacy, legislative advocacy, and speaking with community partners. Fellows completed mentored longitudinal advocacy projects focused on firearm injury prevention, increasing underrepresented minority student exposure to health careers, and understanding caregiver hesitancies regarding the COVID-19 vaccine. This curriculum may serve as a model for integration of advocacy education into PEM and other pediatric subspecialty fellowships.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836537","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

Increasing Incidence of Neonatal HSV in the United States: A Public Health Challenge. 美国新生儿 HSV 发病率不断上升：公共卫生的挑战。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-14 DOI: 10.1542/peds.2024-070052

Sanjay Mahant,David W Kimberlin

引用次数: 0

What's Old Is New Again: Measles. 旧貌换新颜麻疹

IF 8 2区医学

Pediatrics Pub Date : 2025-04-11 DOI: 10.1542/peds.2025-071332

Caitlin Naureckas Li,Sheldon L Kaplan,Kathryn M Edwards,Gary S Marshall,Sarah Parker,C Mary Healy

{"title":"What's Old Is New Again: Measles.","authors":"Caitlin Naureckas Li,Sheldon L Kaplan,Kathryn M Edwards,Gary S Marshall,Sarah Parker,C Mary Healy","doi":"10.1542/peds.2025-071332","DOIUrl":"https://doi.org/10.1542/peds.2025-071332","url":null,"abstract":"Measles is resurging in the United States fueled by decreasing vaccination rates and rising vaccine hesitancy. Clinicians are confronted with a highly infectious vaccine-preventable disease that is unfamiliar to them since, as a result of routine childhood vaccination with measles, mumps, and rubella (MMR) vaccine, measles was declared non-endemic in the U.S. in 2000 and many pediatricians have never seen a case. In this article, we provide an update on measles presentation, clinical course, and outcomes by reviewing the literature and sharing the expertise of senior pediatric infectious disease physicians with experience in caring for children infected with measles. Measles typically presents with a recognizable clinical picture, allowing providers to appropriately triage cases, make the diagnosis, and implement infection control practices to mitigate transmission. Measles is associated with complications, including frequent pulmonary infections and central nervous system involvement which may result in morbidity and mortality. Since treatment options for measles are limited, prevention through vaccination and contact tracing are the mainstays in controlling measles outbreaks. Given the high infectivity of this virus, health care providers are an essential first line of defense for communities. Providers can protect children through advocacy for vaccination including effective communication techniques to educate parents and caregivers about measles infection and the benefits of vaccination. They can also maintain a high clinical index of suspicion so that appropriate infection prevention strategies are rapidly implemented when appropriate.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822765","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

Cord Blood Treatment for Children With Cerebral Palsy: Individual Participant Data Meta-Analysis. 脑瘫儿童脐带血治疗：个体参与者数据荟萃分析

IF 8 2区医学

Pediatrics Pub Date : 2025-04-11 DOI: 10.1542/peds.2024-068999

Megan Finch-Edmondson,Madison C B Paton,Annabel Webb,Mahmoud Reza Ashrafi,Remy K Blatch-Williams,Charles S Cox,Kylie Crompton,Alexandra R Griffin,MinYoung Kim,Steven Kosmach,Joanne Kurtzberg,Masoumeh Nouri,Mi Ri Suh,Jessica Sun,Morteza Zarrabi,Iona Novak

{"title":"Cord Blood Treatment for Children With Cerebral Palsy: Individual Participant Data Meta-Analysis.","authors":"Megan Finch-Edmondson,Madison C B Paton,Annabel Webb,Mahmoud Reza Ashrafi,Remy K Blatch-Williams,Charles S Cox,Kylie Crompton,Alexandra R Griffin,MinYoung Kim,Steven Kosmach,Joanne Kurtzberg,Masoumeh Nouri,Mi Ri Suh,Jessica Sun,Morteza Zarrabi,Iona Novak","doi":"10.1542/peds.2024-068999","DOIUrl":"https://doi.org/10.1542/peds.2024-068999","url":null,"abstract":"CONTEXTUmbilical cord blood (UCB) is a novel treatment for cerebral palsy (CP), with trials indicating UCB can improve gross motor function. However, heterogeneity has limited the ability to interpret findings.OBJECTIVEAssess the safety and efficacy of UCB for improving gross motor function in children with CP, including exploring cell dose effect and responder subgroups.DATA SOURCESIndividual participant data from published reports and registered trials identified via systematic searches.STUDY SELECTIONStudies administering UCB to individuals with CP collecting Gross Motor Function Measure (GMFM) scores.DATA EXTRACTIONA 1-stage individual participant data meta-analysis was conducted in R to obtain the pooled effect of UCB and cell dose effect on GMFM using linear mixed models. Responder subgroups were also investigated.RESULTSFour hundred ninety-eight participant data records were obtained from 11 studies. Main analysis of 170 participants treated with UCB and 171 controls demonstrated UCB increased mean GMFM-66 score compared with controls by 1.36 points at 6 months (95% CI, 0.41-2.32; P = .005) and 1.42 at 12 months (95% CI, 0.31-2.52; P = .012). Mean GMFM-66 effect size increased with increasing cell dose at 3 (P < .001) and 12 months (P = .047). CP severity and baseline age were associated with GMFM-66 effect size. The rate of serious adverse events was similar between groups.LIMITATIONSHeterogeneity across variables and time points, reducing subanalysis power.CONCLUSIONSUCB is safe and provides benefit for improving gross motor function in some children with CP, with higher doses associated with increased effect size. Younger participants (aged approximately <5 years) with milder CP showed increased benefit. Findings will help design future trials with precision.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822472","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

Cord Blood Treatment for Children With Cerebral Palsy. 脑瘫儿童的脐带血治疗。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-11 DOI: 10.1542/peds.2024-070467

Peter Rosenbaum,Robert Palisano

引用次数: 0

Reducing Disparities in Nonaccidental Trauma Evaluations in Emergency Departments. 减少急诊部门非意外创伤评估的差异。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-10 DOI: 10.1542/peds.2024-067809

Arianne L Baker,Robert H Rosen,Jessica K Creedon,Celeste R Wilson,Wee-Jhong Chua,Lois K Lee

引用次数: 0

Well-Child and Hematology Visit Adherence Among Youth With Sickle Cell Disease. 青少年镰状细胞病患儿血液学随访依从性

IF 8 2区医学

Pediatrics Pub Date : 2025-04-10 DOI: 10.1542/peds.2024-069448

Huey-Fen Chen,Laura Chavez,Susan Creary

引用次数: 0

Urine Dipstick for the Diagnosis of Urinary Tract Infection in Febrile Infants Aged 2 to 6 Months. 尿试纸对2 ~ 6月龄发热婴儿尿路感染的诊断价值。

IF 6.2 2区医学

Pediatrics Pub Date : 2025-04-01 DOI: 10.1542/peds.2024-068671

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

{"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":"Objective: 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.Methods: 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.Results: 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%).Conclusion: 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.","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}

引用次数: 0

Orchestrating a Successful Veto Campaign Against a Detrimental School Immunization Bill. 策划了一场成功否决有害学校免疫法案的运动。

IF 6.2 2区医学

Pediatrics Pub Date : 2025-04-01 DOI: 10.1542/peds.2024-068983

Beth Bloom Emrick, Elizabeth A Copenhaver, Jennifer Gerlach, Jamie L Jeffrey, Andrea M Lauffer, Kathleen Martin, Youmna Mousattat, Lisa M Costello

{"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":"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.","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}

引用次数: 0