Journal of pediatrics. Clinical practice最新文献

{"title":"Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic.","authors":"Emilia Núñez-Peña, Ryan P Kelly, Santiago Campos, Maria C Diaz, Pamela A Castillo, Shivangi Kataria, Alexia M Perez, Maria Dolores Beletanga, Alcy R Torres","doi":"10.1016/j.jpedcp.2024.200131","DOIUrl":"10.1016/j.jpedcp.2024.200131","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this retrospective study is to identify factors associated with loss to follow-up for postconcussion clearance in pediatric patients by comparing loss to follow-up and full clearance patients.</p><p><strong>Study design: </strong>This retrospective single-center cohort study analyzed 140 consecutive patients at a pediatric concussion clinic of a safety-net hospital for loss to follow-up, defined as not achieving clearance at last appointment. Univariate and multivariate regression models were fit on variables of interest, including demographic, mechanism and severity of concussion, and characteristics of the first evaluation postconcussion and follow-up management.</p><p><strong>Results: </strong>Of the sample, 40% (n = 56) achieved clearance and 60% (n = 84) were lost to follow-up. Median age was 15 (IQR 11-17), with male predominance (60.7%). Living with a biological parent (OR = 0.145, 95% CI = 0.028-0.760) and sports involvement (OR = 0.256, 95% CI = 0.092-0.764) were protective factors, while being 10 years old or older (OR = 13.466, 95% CI = 2.792-64.958) and attending 2 or fewer follow-up appointments (OR = 19.027, 95% CI = 4.991-72.533) were risk factors for loss to follow-up. No significant differences were found between sex, race, driving distance, type of insurance, and mechanism of injury.</p><p><strong>Conclusions: </strong>Living with a biological parent and involvement in sports showed to be protective factors for loss to follow-up. Age at time of concussion and number of appointments were risk factors. A \"golden window\" of 2 appointments was identified, highlighting the need of a strong rapport and engagement in shared decision-making. Future directions include prospective studies implementing strategies targeting adolescents and building a strong patient-provider relationship.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200131"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804199","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":"Impact of Continuous Glucose Monitoring on Hemoglobin A1c and Height Trends in Latin American Children with Type 1 Diabetes Onset over 3 Years: A Multicenter Study.","authors":"Valeria Hirschler, Claudia Molinari, Claudio D Gonzalez","doi":"10.1016/j.jpedcp.2024.200130","DOIUrl":"10.1016/j.jpedcp.2024.200130","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate changes in hemoglobin A1c (HbA1c) levels and <i>z</i>-height over 3 years based on continuous glucose monitoring (CGM) usage among children with new-onset type 1 diabetes (T1DM) from various Latin American centers.</p><p><strong>Study design: </strong>Data on <i>z</i>-height, CGM access, and HbA1c (%) were collected for Latin American children aged 6 months to 18 years with T1DM onset from 19 centers in a retrospective analysis of medical records, from 2020 to 2023. A 2-way ANOVA method with repeated measures and multiple regression analyses were performed.</p><p><strong>Results: </strong>We included 433 children (46.0% female) aged 8.7 ± 3.7 years; 199 (45.9%) used CGM. The mean HbA1c was significantly lower in years 1, 2, and 3 than at baseline in children with CGM, but not those without CGM. The <i>z</i>-height decreased significantly with the years in both groups. However, the CGM users showed a significantly greater height in years 2 and 3 than the nonusers. Multiple linear regression analysis showed that CGM users exhibited a significantly lower incremental area under the curve (AUC) for HbA1c during follow-up than nonusers. Furthermore, a lower incremental AUC for HbA1c was associated with a smaller decremental AUC for <i>z</i>-height (<i>R</i> ² = 0.19). Multiple logistic regression analysis revealed that children with CGM were 80% more likely (OR, 0.22; 95% CI, 0.1-0.6) to achieve an HbA1c of <7% in the third year of follow-up.</p><p><strong>Conclusions: </strong>This study reveals a significant association between CGM use and lower HbA1c from the onset of T1DM over a 3-year follow-up in Latin American children. Further prospective studies should be performed to confirm this finding.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200130"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788329","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 Comparison of the 2022 Versus 2011 National Institute of Child Health and Human Development Web-Based Risk Estimator for Bronchopulmonary Dysplasia.","authors":"Mitchell Kinkor, Jake Schneider, Farhath Sulthana, Janelle Noel-Macdonnell, Alain Cuna","doi":"10.1016/j.jpedcp.2024.200129","DOIUrl":"10.1016/j.jpedcp.2024.200129","url":null,"abstract":"<p><strong>Objective: </strong>To compare the predictive accuracy of the 2022 vs 2011 National Institute of Child Health and Human Development estimator for identifying infants at high risk for bronchopulmonary dysplasia (BPD).</p><p><strong>Methods: </strong>We conducted a single-center retrospective study of infants ≤28 weeks' gestation. Demographic and respiratory support data were used to calculate risk for BPD or death by the BPD estimators. Our outcomes of interest included (1) treatment with systemic steroids for BPD and (2) composite outcome of death or highest severity of BPD at 36 weeks' postmenstrual age. We used c-statistics and area under receiver operator characteristic curves (AUC) to compare accuracy of the BPD estimators.</p><p><strong>Results: </strong>A total of 159 infants (mean gestational age, 26 weeks; mean birth weight, 837 g) were included. Steroid treatment for BPD occurred in 61 infants. We found that predictive accuracy was similar for both 2022 and 2011 BPD estimators, with c-statistics ranging from 0.77 to 0.89, indicating good-to-excellent accuracy for predicting steroid treatment. Twenty-one infants had death or grade 3 BPD based on definitions used in the 2022 estimator, and 68 infants had death or severe BPD based on definitions used in the 2011 estimator. Overall, we found both BPD estimators had poor AUC for predicting infants at high risk for death or highest severity of BPD, with the exception of the 2022 estimator, which had an acceptable AUC of 0.773 on postnatal day of life 28.</p><p><strong>Conclusions: </strong>The 2022 and 2011 BPD estimators both demonstrate similar good-to-excellent accuracy for identifying infants at high risk for steroid treatment, but poor-to-fair accuracy for predicting death or highest severity of BPD at 36 weeks' postmenstrual age.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200129"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776305","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":"X-linked Thrombocytopenia with Normal Wiskott-Aldrich Syndrome Protein Expression in Lymphocytes and a Novel Wiskott-Aldrich Syndrome Protein Gene Variant: A Case Report and Brief Review of the Literature.","authors":"Serena Hamanaka, Toru Uchiyama, Tadashi Kaname, Motohiro Matsui, Hiroshi Yoshihashi, Atsushi Makimoto, Yuki Yuza, Akira Ishiguro","doi":"10.1016/j.jpedcp.2024.200128","DOIUrl":"10.1016/j.jpedcp.2024.200128","url":null,"abstract":"<p><p>We present a case of X-linked thrombocytopenia (XLT) with a novel WAS gene variant expressing a normal amount of Wiskott-Aldrich syndrome protein (WASp) in lymphocytes. XLT usually decreases WASp expression not only in platelets, but also in lymphocytes. However, there were cases, such as the present one, in which WASp was expressed normally in lymphocytes and absent only in platelets. Our finding suggests that it is of greater diagnostic sensitivity to perform an expression analysis of WASp in both platelets and lymphocytes when XLT is suspected.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200128"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776310","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 Method, Nicotine Exposure, and Growth during Infancy.","authors":"Edmond D Shenassa, Edoardo Botteri, Hanne Stensheim","doi":"10.1016/j.jpedcp.2024.200127","DOIUrl":"10.1016/j.jpedcp.2024.200127","url":null,"abstract":"<p><strong>Objective: </strong>To answer 3 questions: (1) Are infants breastfed by smokers at risk of rapid weight and length gain? (2) Is rapid growth during infancy partially attributable to ingestion of smokers' breastmilk? (3) If so, what are the implications for breastfeeding by smokers?</p><p><strong>Study design: </strong>Using data from the Norwegian Mother, Father and Child Cohort Study and Medical Birth Registry of Norway (n = 54 522), we examined changes in weight, length, weight-for-length z-score (WFLZ) during infancy in the context of maternal smoking (0, 1-10, or >10 cigarettes/day) and feeding method during the first 6 months (breastfed, formula fed, mixed fed). We fit generalized linear models, adding a smoking by feeding method interaction term to evaluate the effect of ingesting smokers' breastmilk.</p><p><strong>Results: </strong>Breastfed infants of both light and heavy smokers experienced WFLZ gains of 0.05 (95% CI, 0.01-0.09) and 0.13 (95% CI, 0.07-0.18), respectively. Among mixed-fed infants, only heavy maternal smoking predicted WFLZ gain (0.10; 95% CI, 0.05-0.16). Among exclusively formula-fed infants, maternal smoking did not predict rapid growth. Interaction models suggest that infants ever breastfed (ie, breastfed and mixed-fed groups combined) by heavy smokers gained weight (100 g; 95% CI, 30-231) and length (2.8 mm; 95% CI, 0.1-5.6), attributable to ingesting smoker's breastmilk.</p><p><strong>Conclusions: </strong>Infants breastfed by smokers experience rapid growth; some of these gains are attributable to ingesting smokers' breastmilk. Among infants breasted by light smokers, these gains are within the range of normative growth patterns for healthy, breastfed infants.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200127"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11824624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416666","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":"Cerebral and Splanchnic Tissue Oxygenation Are Significantly Affected in Premature infants with Ductal-Dependent Congenital Heart Disease.","authors":"Anastasiya Mankouski, Timothy M Bahr, Katherine L Braski, Kimberlee Weaver Lewis, Mariana C Baserga","doi":"10.1016/j.jpedcp.2024.200126","DOIUrl":"10.1016/j.jpedcp.2024.200126","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether premature infants with prostaglandin (PGE)-dependent congenital heart disease (CHD) have impaired cerebral and splanchnic oxygenation (rSO₂) using near infrared spectroscopy (NIRS).</p><p><strong>Study design: </strong>Cerebral and splanchnic rSO₂ were monitored using NIRS for 48 hours in premature infants <36 weeks gestational age with PGE-dependent CHD and control infants (no CHD or patent ductus arteriosus). Both groups were receiving gavage enteral feedings and were >14 days of life. Mixed effects model estimated the effect of CHD and feedings on splanchnic and cerebral NIRS and accounted for multiple measurements on the same participant at 3 different times around feedings (30 minutes before, during, and 30 minutes after feedings).</p><p><strong>Results: </strong>Twenty-four participants were enrolled in the study (10 with CHD and 14 controls). The final dataset included 897 measurements from 23 participants. The median gestational age and birthweight were comparable between case and control groups (34 vs 33 weeks gestational age; mean birthweight of 1811 g vs 1820 g, respectively). On average, cerebral NIRS measurements were 9.5 points higher in controls than cases (<i>P</i> = .003); and splanchnic NIRS measurements were 13.1 points higher in controls than cases (<i>P</i> = .001). The mean cerebral NIRS measurements at baseline, during feeding, and after feeding were 64.0 ± 10.4, 64.5 ± 9.9, and 64.2 ± 9.9 in cases, respectively; and 73.3 ± 6.9, 73.1 ± 6.8, 73.5 ± 6.9 in controls, respectively. The mean splanchnic NIRS measurements at baseline, during feeding, and after feeding were 34.4 ± 15.8, 37.2 ± 14.8, and 38.3 ± 16.1 in cases, respectively; and 50.7 ± 11.0, 51.6 ± 11.1, 50.6 ± 13.5 in controls, respectively.</p><p><strong>Conclusions: </strong>These results demonstrate significantly lower cerebral and splanchnic rSO₂ in premature infants with PGE-dependent CHD compared with control infants. These data raise concerns regarding how unrepaired cyanotic CHD can limit systemic oxygenated blood flow chronically, directly contributing to cerebral and gastrointestinal hypoperfusion and ischemia, ultimately increasing the risk for poor neurodevelopmental outcomes and necrotizing enterocolitis in these premature infants.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200126"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776306","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":"Pulse Oximetry-Based Critical Congenital Heart Disease Screening and Its Differential Performance in Rural America.","authors":"Krishna Kishore Umapathi, John G Frohna","doi":"10.1016/j.jpedcp.2024.200125","DOIUrl":"10.1016/j.jpedcp.2024.200125","url":null,"abstract":"","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200125"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776307","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":"Costs of Care for Neonates with Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia and Validation of the Canadian Neonatal Network Costing Algorithm.","authors":"Elias Jabbour, Pia Wintermark, Wijdan Basfar, Sharina Patel, Petros Pechlivanoglou, Prakesh Shah, Marc Beltempo","doi":"10.1016/j.jpedcp.2024.200124","DOIUrl":"10.1016/j.jpedcp.2024.200124","url":null,"abstract":"<p><strong>Objective: </strong>Therapeutic hypothermia (TH) is the standard treatment for neonates with hypoxic-ischemic encephalopathy (HIE). Validated cost estimates are required to better evaluate the cost-effectiveness of additional interventions during TH. The goal of this study is to identify clinical factors associated with costs of care and validate the Canadian Neonatal Network (CNN) costing algorithm for neonates with HIE receiving TH.</p><p><strong>Study design: </strong>Single-center retrospective cohort study among neonates with HIE treated with TH in a tertiary neonatal intensive care unit from 2016 to 2018. Actual costs per patient were obtained from the hospital cost accounting system, Coût par Parcours de Soinset de Services, and linked to patient data. Estimated costs per patient were calculated using the CNN case-costing algorithm. Neonates were grouped into cost tertiles to identify characteristics of high resource users. Comparisons of actual costs and estimated costs were performed across 8 cost domains.</p><p><strong>Results: </strong>Among 98 neonates treated with TH, 77 (79%) had mild-moderate HIE and 21 (21%) had severe HIE on admission. Factors associated with higher costs were severity of HIE and other markers of disease severity (seizures, mechanical ventilation, length of stay, and presence of brain injury on magnetic resonance imaging). Total median cost per neonate was $24,692 [IQR: $17,466; $39,234], which highly correlated with the CNN algorithm (median: $28 558 [IQR: $23 644; $40 704]) (R = 0.93, <i>P</i> < .01). The mean difference in total costs between estimates was $5339 (95% CI: $2697, $7981). There was a moderate-to-strong correlation between actual and estimated costs in 5/8 cost domains (R range: 0.68-0.98).</p><p><strong>Conclusions: </strong>Severity of HIE and other markers of disease severity were associated with higher hospital costs. The CNN costing algorithm cost estimates for neonates with HIE treated with TH highly correlate with actual costs but overestimates the costs by approximately 15%.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200124"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11824623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416665","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":"Status Epilepticus with Fever in a Toddler with Pyogenic Meningitis Due to Complicated Acute Sphenoid Sinusitis.","authors":"Jay Pershad, Lexi Crawford, Diego Preciado, Dana Harrar, Jose Molto, Craig Shapiro","doi":"10.1016/j.jpedcp.2024.200123","DOIUrl":"10.1016/j.jpedcp.2024.200123","url":null,"abstract":"<p><p>We present a toddler with acute sphenoid sinusitis presenting as status epilepticus with fever, intracranial abscess and meningitis. Cerebrospinal fluid analysis suggested bacterial meningitis, but polymerase chain reaction test was positive for human herpes virus 6. We highlight diagnosis and treatment of this uncommon condition.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"14 ","pages":"200123"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776308","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":"Communities Disproportionately Affected by Carbon Monoxide Exposure After Winter Storm Uri.","authors":"Elyse N Portillo, Casandra Quiñones, Zachary C Foughty, Ryan Ramphul, Asha T Morrow, Kathryn Fisher, Stephen A Harding, Elizabeth A Camp, Shubhada Hooli, Eric A Russell","doi":"10.1016/j.jpedcp.2024.200114","DOIUrl":"10.1016/j.jpedcp.2024.200114","url":null,"abstract":"<p><p>Extreme cold in February 2021 precipitated prolonged power failure in Texas. In Houston, many patients presented for carbon monoxide exposure from neighborhoods with lower per capita income, higher rates of limited English proficiency, and greater median Social Vulnerability Indices than Greater Houston. Weather-related disasters disproportionately affect socially vulnerable communities.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"13 ","pages":"200114"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11258496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736255","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}