Journal of pediatrics. Clinical practice最新文献

{"title":"Nebulized-Swallowed Albuterol for the Treatment of Food Impaction in Pediatric Patients with Eosinophilic Esophagitis: A Novel Nonendoscopic Approach.","authors":"Thirumazhisai S Gunasekaran, Kiranmai Gorla, James Berman, Vrinda Bhardwaj","doi":"10.1016/j.jpedcp.2026.200212","DOIUrl":"10.1016/j.jpedcp.2026.200212","url":null,"abstract":"<p><p>Food impaction (FI) is a manifestation of eosinophilic esophagitis (EoE) and requires endoscopic removal. We report the response to nebulized albuterol in 5 children with EoE and FI. Albuterol (2.5 mg/3 mL) was administered via nebulizer, with instructions to breathe and swallow the aerosol condensate. Four of 5 patients experienced relief of the impaction. Endoscopy with biopsies performed acutely in 1 patient and subsequently in the others confirmed EoE in all patients. This technique represents a novel approach for the nonendoscopic management of FI in EoE.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200212"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13208829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feeding Practices in Simple Gastroschisis: Insights into Practice Variation from a Multidisciplinary Survey.","authors":"Elizabeth Reynolds, Anjali Cera, Nicole Cacho, Twila Marie Cuayzon Ong, Jamie E Anderson, Jennifer L Rosenthal, Daniel A DeUgarte, Kara L Calkins, Minna M Wieck, Geoanna M Bautista","doi":"10.1016/j.jpedcp.2026.200211","DOIUrl":"10.1016/j.jpedcp.2026.200211","url":null,"abstract":"<p><strong>Objective: </strong>There is limited evidence to guide feeding practices for neonates with simple gastroschisis. Current management consists of a combination of clinician judgment and historic practice patterns. This study aims to characterize practice variability and identify opportunities for standardization to improve patient outcomes.</p><p><strong>Study design: </strong>In this cross-sectional study, we surveyed neonatal providers on their feeding practices for simple gastroschisis, focusing on the initiation and advancement of enteral nutrition after abdominal closure. The 27-question survey was administered to members of the American Pediatric Surgical Association and the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine between October 2024 and January 2025. Data were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Of the 467 respondents, the majority were neonatologists (51%) and pediatric surgeons (42%) working in academic centers (75%) with level III or IV neonatal intensive care units (98%). Participants reported near-universal use of an enteric drainage tube after abdominal closure (99%). One-half reported no gastroschisis feeding protocols at their institution, and instead, across all respondents, rely on evidence of return of bowel function before starting feeds (84%) typically with human milk (86%), by bottle (60%) and initial volumes of 10-20 mL/kg/day.</p><p><strong>Conclusions: </strong>This study demonstrated variable approaches to feeding hospitalized neonates with simple gastroschisis. Evidence-based and standardized guidelines tailored to this population that support the timely and effective initiation and progression of feeds may help improve clinical outcomes.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200211"},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-Year Mortality in Infants Born Moderately Preterm and Late Preterm: A National Register Study.","authors":"Kati Kallio, Riitta Ojala, Tiina Luukkaala, Outi Tammela","doi":"10.1016/j.jpedcp.2026.200206","DOIUrl":"10.1016/j.jpedcp.2026.200206","url":null,"abstract":"<p><strong>Objective: </strong>To investigate first-year mortality and predictors and causes of death in infants born moderately preterm (MP; birth at 32^0/7-33^6/7 weeks of gestation) and late preterm (LP; 34^0/7-36^6/7) compared with infants born very preterm (<32^0/7) and term (≥37^0/7-41⁶ ^/7) and to establish mortality rates by region, hospital level, and time.</p><p><strong>Study design: </strong>Data on all infants (n = 1 546 787) born in Finland between 1991 and 2016 were collected from national registers. Of those born prematurely (5.9%), infants born MP and LP accounted for 85,9%.</p><p><strong>Results: </strong>Early, late, and postneonatal mortality decreased with advancing gestational age. Despite overall declines, early neonatal mortality remained significantly greater in infants born MP and LP than in infants born at term. Over time, early neonatal mortality decreased only in MP and LP groups, whereas first-year mortality declined in infants born MP and LP. Predictors of death in all mortality categories in infants born MP and LP included small for gestational age, low Apgar score, and ventilator treatment. Some regional and hospital-level differences in early neonatal mortality were observed. Causes of death in infants born MP and LP resembled those of term more than infants born very preterm, with congenital anomalies being the most common, albeit not easily preventable causes of death.</p><p><strong>Conclusions: </strong>Infants born MP and LP had an elevated risk of early neonatal mortality compared with infants born at term. Continued reductions may be achieved by targeting preventable causes such as asphyxia and respiratory distress, while counseling-based interventions may help prevent sudden infant death syndrome and reduce late neonatal and postneonatal mortality.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200206"},"PeriodicalIF":0.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant Cardiac Rhythm Disturbances in Infant Bronchiolitis: A Holter-Based Prospective Analysis.","authors":"Allon Raphael, Hazar Asad, Moshe Rav-Acha, Oholi Tovia-Brodie, Yoav Michowitz, Ziv Dadon, Yechiel Schlesinger, Amiram Nir","doi":"10.1016/j.jpedcp.2026.200209","DOIUrl":"10.1016/j.jpedcp.2026.200209","url":null,"abstract":"<p><strong>Objective: </strong>Bronchiolitis is a major cause of respiratory illness in infants. Few studies have demonstrated arrhythmias during bronchiolitis, including bradycardia and atrioventricular block, some requiring pacemaker implantation. However, the association between bronchiolitis and cardiac arrhythmias remains unclear. In this work we sought to investigate the incidence and characteristics of arrhythmias during bronchiolitis in infants younger than 1 year of age.</p><p><strong>Study design: </strong>A single-center, prospective cohort study was conducted on infants hospitalized with a clinical diagnosis of bronchiolitis. Demographic and clinical data were collected via questionnaire. All infants underwent overnight Holter monitoring during hospitalization.</p><p><strong>Results: </strong>Among 100 enrolled infants (79% positive for respiratory syncytial virus), 18 (18%) demonstrated arrhythmias: sinus arrest (2-13 seconds) in 8 infants, bradycardia <60 bpm in 7 infants, and frequent atrial premature complexes (3%-18% of beats) in 3 infants. Follow-up Holter recordings in 7 patients (38%) showed resolution of arrhythmias within 1-4 months. No significant demographic or clinical predictors were identified. None of the infants exhibited symptoms (eg, cyanosis, unresponsiveness) associated with arrhythmia severity.</p><p><strong>Conclusions: </strong>Our study shows that bronchiolitis is associated with significant arrhythmias in infants, particularly sinus arrest, bradycardia, and atrial premature complexes. In our cohort, none of the infants with significant arrhythmia required arrhythmia intervention. Clinicians should be aware of this association and consider delaying decisions regarding pacemaker implantation until after the resolution of bronchiolitis even in cases of infants with severe bradycardia. Future investigations should explore the pathophysiology and prognostic implications of this phenomenon.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200209"},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Polysubstance Exposure and Neonatal Weight Loss Among Infants Exposed to Opioids.","authors":"Nicole Andersen, Andrew Wiese, Nicolas Gargurevich, Julia C Phillippi, Sarah F Loch, William D Dupont, Stephen W Patrick","doi":"10.1016/j.jpedcp.2026.200210","DOIUrl":"10.1016/j.jpedcp.2026.200210","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the weight trajectories of infants exposed to opioids and evaluate the association between different exposures and risk of excessive neonatal weight loss.</p><p><strong>Study design: </strong>Using mother-baby linked electronic health records, vital records, and claims data, we identified a retrospective cohort of infants exposed to opioids born at a large, academic medical center (2010-2021). We characterized prenatal substance exposures 90 to 2 days before delivery, including medications for opioid use disorder (MOUD), non-MOUD opioids, selective serotonin reuptake inhibitors, benzodiazepines, gabapentin, cigarette smoking, and toxicology evidence of opioids and nonopioid exposures (eg, barbiturates, cannabinoids, amphetamines, cocaine). We parameterized neonatal weight loss as the maximum percentage decrease from birth weight in the first 14 days of life during birth hospitalization. We used multivariable linear regression to compare the association between prenatal exposures and maximum percentage weight loss.</p><p><strong>Results: </strong>Among 868 maternal-infant dyads exposed to opioids that were identified, 622 (71.7%) had prenatal exposure to at least 1 additional substance. Infants with additional prenatal exposures had a greater median weight loss and a later nadir in weight loss compared with those without additional exposures (<i>P</i> < .001). In analyses examining individual substances, MOUD prescriptions (coefficient 0.99; 95% CI 0.50-1.48) and positive toxicology for nonopioid drugs (coefficient 0.53; 95% CI 0.08-0.98) were associated with a greater maximum percentage weight loss.</p><p><strong>Conclusions: </strong>Exposure to MOUD and nonopioid exposures were associated with greater weight loss among infants exposed to opioids during the first 14 days of life. These findings inform the clinical management of infants exposed to opioids to mitigate weight loss during the neonatal hospitalization.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200210"},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148230060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age of Entry into Early Intervention: Influence of the COVID-19 Pandemic, Telehealth, and Other Factors.","authors":"Lauren M Little, Sheerah Neal Keith, Anna Wallisch, Beth S Rous, Tricia Johnson, Waylon J Howard, Scott Tomchek","doi":"10.1016/j.jpedcp.2026.200207","DOIUrl":"10.1016/j.jpedcp.2026.200207","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the extent to which age of early intervention (EI) enrollment was influenced by policy changes associated with the introduction of telehealth and hybrid service delivery models into a statewide EI system across COVID-19 periods (pre-COVID [in person only], COVID [telehealth only], post-COVID [hybrid]).</p><p><strong>Study design: </strong>We used administrative data from Kentucky's EI system, Technology-assisted Observation and Teaming Support system. The Technology-assisted Observation and Teaming Support system is a web-based, real-time, data management platform that tracks children in Kentucky's EI as they enter and progress through Part C services. We analyzed data from 34 683 children from 2015 to 2023. We used a general linear model to investigate whether age of enrollment into EI was influenced by child factors and safety net program use across COVID-19 periods.</p><p><strong>Results: </strong>Regardless of the COVID-19 period and associated service delivery models, factors that supported early entry into EI included the use of Women, Infants, and Children, having an established condition, and female sex. White children entered the system significantly earlier than Black, Hispanic, and Asian, children across all COVID-19 periods (all <i>P</i> < .001). During the pre-COVID-19 period, those using Medicaid entered EI at younger ages than those using private insurance (<i>P</i> < .01); however, differences in age of entry by insurance dissipated during and post-COVID-19.</p><p><strong>Conclusion: </strong>Service delivery model policies across COVID-19 pandemic periods did not significantly influence age of entry overall. Differences by race, ethnicity, sex, and safety net program utilization persisted throughout COVID-19 periods, likely exacerbated by telehealth access.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200207"},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Parent Survey: Characteristics of Sudden Cardiac Arrest in Youth.","authors":"Amelie Warneryd, Simran Chand, Abenezer Lemma, Martha Lopez-Anderson, Lindsey J Flanagan, Maryam Naim, Victoria L Vetter","doi":"10.1016/j.jpedcp.2026.200208","DOIUrl":"10.1016/j.jpedcp.2026.200208","url":null,"abstract":"<p><strong>Objective: </strong>To describe characteristics of sudden cardiac arrest (SCA) in youth on the basis of a parent survey and identify potential associations.</p><p><strong>Study design: </strong>A cross-sectional retrospective observational survey of Parent Heart Watch members whose children had experienced SCA or sudden cardiac death. Questions included individual and family information. We present summary statistical analyses for the overall group, survivors, and nonsurvivors.</p><p><strong>Results: </strong>There were 76 responses: 17.1% (13) survivors with no significant demographic differences by survivors/nonsurvivors except sex (<i>P</i> = .04). Total study population age at SCA, median, 15.5 years; age range, 5.5-28 years; Sex: male, 76.3%; Race/ethnicity: White, 82.9%; Black, 4.0%; >1 race, 5.3%; unknown, 7.9%; Hispanic, 10.5%; Family history SCA<50 years, 15.8%. Potential cardiovascular symptoms were common, 68.4%. No significant symptom difference between survivors/nonsurvivors who experienced fatigue, palpitations, and chest pain. Activity-related SCA was common, 61.9%. At least 1 medication or substance, ie, caffeine, energy drinks, alcohol, or tobacco, was consumed at or around the time of the cardiac arrest in 56.6%. More arrests at home vs school in nonsurvivors. Survival in 5 of 15 events (33%) when automated external defibrillator (AED) on site; higher survival with combined cardiopulmonary resuscitation/AED use (<i>P</i> = .001) and AED shock delivered (<i>P</i> = .004).</p><p><strong>Conclusions: </strong>Symptoms were common but frequently not investigated. Family history was often unknown. Potentially important SCA associations include activity, medications/substances, and intercurrent illnesses, often in the presence of underlying and undiagnosed heart conditions. The location of SCA, cardiopulmonary resuscitation, AED use, and Emergency Medical Services arrival time affected survival.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200208"},"PeriodicalIF":0.0,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of Pediatric Palliative Care in Oncology: A Scoping Review.","authors":"Stefanie Stober, Sebastian Hoffmann, Sabine Metzing","doi":"10.1016/j.jpedcp.2026.200205","DOIUrl":"10.1016/j.jpedcp.2026.200205","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric palliative care (PPC) enhances quality of life for children with cancer and their families, yet its systematic integration into oncology practice remains limited, particularly in hospital-based care. This scoping review aimed to map and synthesize international evidence on how PPC is designed, implemented, and evaluated in pediatric oncology inpatient settings, and to identify key barriers and facilitators to its clinical integration.</p><p><strong>Methods: </strong>We conducted a comprehensive search of MEDLINE, CINAHL, PsycINFO, and Web of Science (2014-2025). Reporting followed PRISMA-ScR standards. Data were charted and narratively synthesized.</p><p><strong>Results: </strong>Thirty-four studies from 18 countries met inclusion criteria. Most used qualitative methods (n = 12), followed by retrospective chart reviews (n = 7), surveys (n = 4), and reviews or guidelines (n = 11). Evidence revealed delayed initiation of PPC, heterogeneous service models, and limited outcome evaluation. Seven recurrent barriers emerged: absence of standardized models, structural constraints, inadequate staff training, suboptimal communication and family engagement, emotional and cultural barriers, psychosocial strain, and insufficient evaluation frameworks.</p><p><strong>Conclusions: </strong>These findings highlight a global need to integrate early, family-centered PPC within pediatric oncology inpatient care. Health systems should prioritize staff training, establish adaptable interdisciplinary models, and implement structured evaluation strategies to strengthen the quality and consistency of PPC delivery.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200205"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Fetal Alcohol Spectrum Disorders Learning Collaborative for Pediatric Care Teams.","authors":"Daniel P Alford, Jacqueline S German, Nicole Kitten, Kendra Gludt, Sara Messelt, Ilana Hardesty, Jacey A Greece, Candice Bangham, Amy Harlowe, Michael R Winter, Martha S Fermín, Vincent C Smith","doi":"10.1016/j.jpedcp.2026.200204","DOIUrl":"10.1016/j.jpedcp.2026.200204","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the impact of the SBIRT And FASD Education, Support and Treatment (SAFEST) Choice Learning Collaborative on US pediatric health care teams' knowledge, confidence, and clinical practices related to the identification and management of children with possible or diagnosed fetal alcohol spectrum disorders (FASD).</p><p><strong>Study design: </strong>The SAFEST Choice program included 2 year-long 10-session virtual learning collaboratives based on the Project ECHO (Extension for Community Healthcare Outcomes) model, which included participant case presentations highlighting clinical challenges. Using a pre-/posttest evaluation design, program outcomes included changes in participant FASD-related knowledge, confidence, and practice. Participant case clinical challenges were documented and analyzed for common themes.</p><p><strong>Results: </strong>The program enrolled 105 participants from 23 clinics in 8 states. Clinics attended a median of 9 of 10 ECHO sessions, whereas individual participants attended a median of 5 of 10. Participants were mostly physicians, nurse practitioners, and nurses. Upon program completion, participants reported increased FASD-related knowledge and significant increases in confidence and self-reported practices in screening for prenatal alcohol exposure and counseling families about, and managing patients with, prenatal alcohol exposure and FASD. Participant case clinical challenge themes included when to consider an FASD diagnosis, managing the care of patients with FASD, and addressing FASD-related stigma and bias.</p><p><strong>Conclusions: </strong>The SAFEST Choice program successfully trained pediatric health care teams in 2 year-long FASD learning collaboratives with high levels of participation. Participants had increased self-reported knowledge, confidence, and practice change related to FASD identification and care. This program offers a promising educational model to improve the care of individuals with possible or diagnosed FASD.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200204"},"PeriodicalIF":0.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Outcomes of Hospitalizations for Children with Encephalopathy Associated with Severe Liver Dysfunction.","authors":"Lilia Christner, Achamyeleh Gebremariam, Folafoluwa Odetola","doi":"10.1016/j.jpedcp.2026.200202","DOIUrl":"10.1016/j.jpedcp.2026.200202","url":null,"abstract":"<p><strong>Objective: </strong>To determine patient-level and hospital-level factors independently associated with mortality in pediatric severe liver dysfunction-associated encephalopathy.</p><p><strong>Study design: </strong>This was retrospective analysis of hospitalizations of children 0-20 years old with severe liver dysfunction-associated encephalopathy in the US, using combined administrative data from the 2016, 2019, and 2022 versions of the Kids' Inpatient Database. National estimates of hospitalizations were generated, and multivariable logistic regression models were constructed to determine patient and hospital characteristics independently associated with mortality.</p><p><strong>Results: </strong>Of an estimated 3378 hospitalizations nationally, 94% were to urban teaching hospitals, 67% were of children >5 years, and 56% were of male patients. Comorbidities and multiple organ dysfunction (MOD) were present in 93% and 97% of hospitalizations, respectively. In-hospital mortality was 45%, with average hospital stay of 22 days, and average hospital charge of $622 069 (2022 US dollars). In-hospital mortality was associated with patient characteristics including age, MOD, and the presence of comorbidities, but not hospital characteristics. In comparison with infants, hospitalization of older children was associated with lower odds of mortality. Independent association with greater odds of mortality was observed for each nonhepatic organ dysfunction (OR 1.50; 95% CI 1.38-1.64), and the presence of comorbidities (OR 4.10; 95% CI 2.75-6.13).</p><p><strong>Conclusions: </strong>Nearly 1 in 2 hospitalizations for pediatric severe liver dysfunction-associated encephalopathy ended in death. Hospitalizations occurred predominantly at urban hospitals, with no regional or hospital variation in mortality. Efforts to mitigate mortality need to be individualized and age-specific, with emphasis on preventing or alleviating MOD.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"20 ","pages":"200202"},"PeriodicalIF":0.0,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12997221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}