Hospital pediatrics最新文献

{"title":"Living With Known Unknowns: Prognostic Uncertainty in Congenital Cytomegalovirus Following Diagnosis.","authors":"Megan Honor Pesch, Sean P McKenzie, Tyler G James, Marin Anderson, Gail Demmler-Harrison","doi":"10.1542/hpeds.2026-009558","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009558","url":null,"abstract":"<p><strong>Objective: </strong>To examine how parents experience and navigate prognostic uncertainty following a diagnosis of congenital cytomegalovirus (cCMV) and identify implications for clinical communication and newborn screening.</p><p><strong>Methods: </strong>We conducted in-depth qualitative interviews with 41 birth parents of children with cCMV. Interviews explored diagnosis, communication with health care practitioners, health care navigation, and perceptions of child development. Transcripts were analyzed using inductive reflexive thematic analysis.</p><p><strong>Results: </strong>Prognostic uncertainty emerged as a central and enduring feature of parents' experiences. Five themes characterized how families navigated uncertainty: (1) families live with the burden of an unpredictable future, (2) families struggle to make meaning from incomplete and inconsistent information, (3) families become drivers of the diagnostic journey to gain clarity and control, (4) knowledge provides families direction even when certainty is impossible, and (5) families value early diagnosis because it makes uncertainty more manageable. Uncertainty contributed to anxiety, information seeking, and ongoing monitoring. However, parents consistently valued early diagnosis because it provided direction, facilitated treatment and developmental surveillance, supported access to intervention, and informed decision-making. Rather than eliminating uncertainty, diagnosis transformed an unpredictable future into possibilities on which families could monitor and act.</p><p><strong>Conclusions: </strong>Prognostic uncertainty is an inherent and longitudinal feature of cCMV and should be acknowledged in counseling following the diagnosis. Despite persistent uncertainty, parents valued early identification because it provided direction and opportunities for surveillance and intervention. As cCMV screening expands, family-centered communication, anticipatory guidance, care coordination, and longitudinal support can help families navigate uncertainty over time.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Resident Professional Identity Formation as an Educator.","authors":"Kirsten Snook, Sarah Fox, Kimberly O'Hara, L Barry Seltz","doi":"10.1542/hpeds.2026-009338","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009338","url":null,"abstract":"<p><strong>Objective: </strong>Physicians who identify as clinician-educators are important to advance the field of medicine. Yet, how residents develop an educator identity (EI), and the influence of the clinical learning environment, remains understudied. Data from pediatric programs are particularly lacking. The study objective was to explore pediatric residents' perspectives on their professional identity formation (PIF) as an educator.</p><p><strong>Methods: </strong>Informed by Cruess' model of PIF, we conducted a qualitative study using interviews with 20 pediatric residents from December 2024 to October 2025. Four investigators performed a thematic analysis. Codes were built using an iterative approach and organized into themes. Purposeful sampling continued until reaching information power.</p><p><strong>Results: </strong>Analysis yielded 4 main themes. First, educator PIF was perceived to occur in a progressive but discontinuous fashion throughout residency. Second, the clinical learning environment significantly influences resident educator PIF; one subtheme highlights acquisition of medical knowledge from clinical experiences to build teaching confidence. Autonomy as a teacher is also an essential facilitator of resident educator PIF. Additionally, clinician-educator role models' commitment, enthusiasm, and teaching skills inspire residents to pursue an EI. Third, certain attributes characterize residents who identify as an educator. Finally, a teaching curriculum is key to honing educator skills. Analysis of thematic relationships highlighted self-determination theory as a theoretical framework, as teaching confidence, autonomy, and connection with learners and role models were instrumental in developing an EI.</p><p><strong>Conclusions: </strong>Pediatric resident EI was perceived to progressively develop throughout training and was influenced by the clinical learning environment, characteristic attributes, and a teaching curriculum.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Repeat Steroid Dosing in Children Admitted With Croup.","authors":"Sheila Swartz, Leah Cotter, Brandon Palmer, Gabriel Aguero, Jennifer Hadjiev, Jian Zhang, Ke Yan, Peter Havens","doi":"10.1542/hpeds.2026-009388","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009388","url":null,"abstract":"<p><strong>Objective: </strong>Croup is a common cause of respiratory distress in young children due to airway obstruction from laryngeal edema secondary to viral upper respiratory infection. Our goal was to measure the effect of redosing steroids on the length of stay (LOS) and rates of recurrence of croup symptoms in children hospitalized with uncomplicated croup.</p><p><strong>Patients and methods: </strong>Non-critically ill children hospitalized with croup from 2013 to 2021 were identified using encounter diagnosis codes. Variables including demographic factors, total dexamethasone dose given during hospitalization or within 24 hours of admission, dexamethasone prescribed at discharge, LOS, and recurrence or readmission were obtained by chart review. The Bedside Pediatric Early Warning System score was used to quantify the degree of illness.</p><p><strong>Results: </strong>A total of 486 children were included in the study; 188 (39%) got more than 1 dose of dexamethasone during admission, and 160 (33%) received a prescription for dexamethasone on discharge. Fifty-eight children (12%) had recurrence of symptoms after hospital discharge. Recurrence of symptoms was not associated with total dexamethasone dose administered in the hospital or prescription of a dexamethasone at discharge. When controlling for degree of illness, administration of more than 1 dose of dexamethasone was associated with a 55% longer LOS.</p><p><strong>Discussion: </strong>Repeated steroid dosing in non-critically ill children admitted with croup is associated with an increased LOS without improving readmission or recurrence outcomes even when controlling for degree of illness, although this finding may be driven by immortal time bias or confounding by indication.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient Dexamethasone Redosing in Croup: Randomized Trials and Target Trial Emulation.","authors":"Sanjay Mahant, Peter J Gill, Eyal Cohen","doi":"10.1542/hpeds.2026-009806","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009806","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NICU Observation Prior to Well Newborn Care for Asymptomatic Infants.","authors":"Neha S Joshi, Rakhi Gupta Basuray, Arun Gupta, Julie L Kim, Allison Markowsky, Sandra Motta, Leela Sarathy, Hollyce Tyrrell, Nagma Zafar, Krista Birnie","doi":"10.1542/hpeds.2026-009775","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009775","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Discharge Instructions: Systematic Review of Language and Health Literacy Interventions.","authors":"Alia Almulla, Analyssa Cardenas, Cassandra Nelson, Yasmeen Razvi, Evangeline Tsagarakis, Nneoma Ikechukwu, Victor Do","doi":"10.1542/hpeds.2026-009374","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009374","url":null,"abstract":"<p><strong>Context: </strong>Effective pediatric inpatient discharge relies on clear, responsive communication to support safe transitions from hospital to home. Families who use a language other than English and those with lower health literacy experience disproportionate barriers during discharge, contributing to inequities in postdischarge outcomes. Despite recognition of these disparities, evidence guiding interventions remains fragmented.</p><p><strong>Objective: </strong>To identify and evaluate interventions designed to address language and health literacy barriers in pediatric inpatient discharge, assess their impact on patient and caregiver outcomes, and examine methodological quality to inform best practices.</p><p><strong>Methods: </strong>Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform were searched from inception to June 2025. Eligible studies involved hospitalized pediatric patients and evaluated discharge interventions tailored to families' preferred language, reporting at least 1 discharge-related outcome. Ten studies met criteria. Two reviewers independently extracted data on study characteristics, interventions, and outcomes, and a narrative synthesis was completed because of heterogeneity. Risk of bias analysis was performed.</p><p><strong>Results: </strong>Included studies were heterogeneous in design, interventions, and outcomes, and all were conducted in the United States. Interventions varied substantially and were categorized into health literacy-focused written interventions, language-concordant interventions, multimodal communication strategies, and system-level or workflow-based interventions. Interventions combining language-concordant communication with literacy-informed, multimodal strategies demonstrated more consistent improvements in caregiver understanding. Methodological quality was limited, with substantial risk of bias across studies.</p><p><strong>Conclusions: </strong>Language concordance alone is insufficient to ensure equitable pediatric discharge. Multimodal, literacy-informed strategies that apply universal precautions principles show greater promise but there is limited-quality evidence. Future research should prioritize rigorous designs, patient-centered outcomes, and meaningful family engagement.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GPT-4o Translation of Pediatric Discharge Instructions Across Languages.","authors":"Daniel J Kats, Mondira Ray, Joss Moorkens, Dinesh Rai, Ryan Cl Brewster, Alisa Khan, Benjamin Rader, John S Brownstein, Jonathan D Hron","doi":"10.1542/hpeds.2026-009476","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009476","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients and caregivers who use languages other than English in health care settings rarely receive language-concordant discharge instructions. Large language models show promise for improving access to translations but must be validated to ensure their output is safe for clinical use. This study measured the quality of GPT-4o medical translations to Portuguese, Haitian Creole, and Arabic.</p><p><strong>Methods: </strong>Previously translated personalized discharge instructions (performed by professional human translators) were extracted from inpatient admissions at a large US pediatric academic medical center. The discharge instructions were translated to Portuguese, Haitian Creole, and Arabic by GPT-4o. Medical translators then evaluated the translations using both the Multidimensional Quality Metrics (MQM) framework and a preference scale.</p><p><strong>Results: </strong>Translations of 14 to 20 discharge instructions for each of the 3 languages were evaluated. Noninferiority testing showed no significant difference in translation quality between GPT-4o and human translations for Portuguese and Arabic, but worse performance by GPT-4o than human translations for Haitian Creole (mean MQM score 90.5 ± SD 5.5 vs 97.0 ± SD 2.1). Linguists preferred the human translation over GPT-4o in 69% (SE = 7%) of the Haitian Creole cases.</p><p><strong>Conclusions: </strong>In this cross-sectional study, GPT-4o translation performance of pediatric discharge instructions was noninferior for Portuguese and Arabic but was worse in Haitian Creole. Human validation of medical translations remains necessary for all languages, but large language models can be used to draft high-quality translations in languages with proven high performance, while resources are shifted toward more intensive post-editing of translations in languages with lower performance.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Overview of Interrupted Time Series as a Research Method.","authors":"Megan Smith, Emma Frost, Thevaa Chandereng, Kavita Parikh","doi":"10.1542/hpeds.2026-009232","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009232","url":null,"abstract":"<p><p>Interrupted time series (ITS) study design is increasingly used to evaluate the impacts of guidelines, policy changes, and quality improvement efforts on clinical outcomes. Repeated observations of an outcome of interest over time are \"interrupted\" by an intervention, dividing the study into pre- and postintervention time periods. Regression analysis then compares the level change and slope of the 2 time periods to determine intervention effects. The benefits of this study design include (1) use of lower-cost, preexisting large data sets, (2) reduced susceptibility to confounding by individual-level characteristics with the ability to test for potential biases, and (3) presentation of results in straightforward, easy-to-interpret figures. However, ITS methods require high-quality, consistent data over an extended time frame, and researchers must have a firm grasp of potential confounding variables and selection of appropriate statistical analysis methods. When properly employed, ITS provides a rigorous study design to evaluate outcomes in pediatric populations that may otherwise be difficult to investigate. This primer familiarizes pediatric hospitalists with the basics of employing this study methodology, introduces examples of its utility in the field, and directs readers to existing literature for the more advanced statistical underpinnings of conducting such a study.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Guidance on Neighborhood-Level Social Indices for Pediatric Health.","authors":"Gabriela Escobar, Kylie Seeley, Samantha House, Ananta Addala","doi":"10.1542/hpeds.2026-009449","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009449","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient Pediatric-to-Adult Transition of Care Consultation Delivery: A Mixed-Methods Study.","authors":"Lauren E Wein, Yasmin Marcantonio, Sallie D Allgood, Aidan Berry-Nguyen, Ruchi Doshi","doi":"10.1542/hpeds.2026-009212","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009212","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated an inpatient transition consultation (ITC) for adolescents and young adults (AYAs) with chronic conditions and their caregivers admitted to the hospital to assess ITC content, evaluate how it addressed transition concerns, determine its impact, and identify areas for improvement.</p><p><strong>Patients and methods: </strong>We conducted a mixed-methods study at a tertiary academic medical center. Eligible participants were English-speaking patients aged 18 years or older and/or their caregivers who received an ITC during hospitalization. The ITC was conducted by a physician who focused on assessing transition readiness, providing education and counseling, and planning the transition from pediatric to adult models of care. Data collection included semistructured interviews and a modified Adolescent Assessment of Preparation for Transition (ADAPT) survey. Interviews explored perceptions of the ITC, including the content covered, impact and accountability of the consult, and suggestions for improvement. Qualitative data were analyzed using inductive coding; survey responses were summarized descriptively.</p><p><strong>Results: </strong>Twelve participants representing diverse chronic conditions completed interviews and surveys. Five themes were generated: \"enhanced understanding of self-management in adult care,\" \"anxiety regarding anticipated changes from pediatric to adult care delivery,\" \"reassurance and reduced anxiety following consultation,\" \"importance of support systems for patients and caregivers undergoing transition,\" and \"centering holistic, person-focused care during transition.\"</p><p><strong>Conclusions: </strong>An ITC was perceived as educational, reassuring, and patient-centered. Findings suggest that targeted transition counseling during hospitalization is acceptable to patients and caregivers and may help reduce anxiety surrounding health care transition.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}