Journal of pediatrics. Clinical practice最新文献

{"title":"Do Motor Difficulties in Infancy Predict 7-year-olds' Behavioural Health? Findings from the Avon Longitudinal Study of Parents and Children.","authors":"Emma Butler, Mary Clarke, Michelle Spirtos","doi":"10.1016/j.jpedcp.2025.200167","DOIUrl":"10.1016/j.jpedcp.2025.200167","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether fine- and gross-motor skills in infancy predict child behavioral health at 7 years of age.</p><p><strong>Study design: </strong>Longitudinal cohort data from 6,709 English children were analyzed using regression techniques to investigate whether fine- and gross-motor skills at 18 months, measured by Denver developmental categorized age-adjusted Z-scores, predicted behavioral health at 7 years of age, measured by the total-score on the Strengths and Difficulties Questionnaire.</p><p><strong>Results: </strong>A dose-response relationship exists between fine-motor skills at 18 months and behavioral health at 7 years of age. In fully-adjusted models, (cumulative sociodemographic risk, sex, history of maternal psychological difficulties, gross-motor skills, and gestational age), the odds of experiencing clinical levels of behavioral health symptoms at 7 years of age decreased as fine-motor skills increased. Odds ratios were 0.5 (95% CI 0.2-1.3) for children with below, 0.3 (95% CI 0.1-0.8) for slightly-below, 0.2 (95% CI 0.1-0.4) for average and, 0.1 (95% CI 0.1-0.4) for above-average fine-motor skills compared to children with well-below fine-motor skills. Children with well-below, below, and slightly-below-average fine-motor skills reported almost 6-times, 3-times and double higher rates of clinical behavioural health symptoms at 7-years compared to children with average or above fine-motor-skills. Gross-motor skills were not prognostic of later behavioural health.</p><p><strong>Conclusions: </strong>Infants with any level of fine-motor difficulties had higher rates of parent-reported behavioural health symptoms at 7-years. Fine-motor but not gross-motor skills in infancy are predictive of poor behavioural health at 7-years. Examining how numerous factors such as motor skills, gestational-age and sociodemographic risk combine to predict risk of poor behavioural health may be more useful than considering any individual predictor in isolation.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200167"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877777","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 Between the Child Opportunity Index and Individual Level Social Risks.","authors":"Florinda Islamovic, Samantha Levano, Hemen Muleta, Jonathan M Gabbay, Marina Reznik, Kevin Fiori","doi":"10.1016/j.jpedcp.2025.200169","DOIUrl":"10.1016/j.jpedcp.2025.200169","url":null,"abstract":"<p><strong>Objective: </strong>Area-level indices, including the Child Opportunity Index (COI), are used as proxies for individual Health Related Social Needs (HRSNs). There is increasing literature suggesting limitations of these indices. There is no literature evaluating the relationship between the COI and HRSN in the pediatric population. Our objective is to assess the relationships between the COI 2.0 and 3.0 with individual-level HRSNs among pediatric patients.</p><p><strong>Study design: </strong>Cross-sectional study of pediatric patients screened for HRSN between November 2022 and December 2023 at a large academic hospital in the Bronx, New York. Multivariate logistic regression models were used to assess the association between the COI tertiles and HRSNs. The predictive ability of COI in identifying HRSNs was also calculated.</p><p><strong>Results: </strong>A total of 17,760 children with HRSNs and geographic identifiers were included in the analysis with 16% reporting at least one HRSN and approximately 90% living in the low COI areas. In adjusted models, national normalized COI 3.0 showed significantly higher odds of HRSNs in moderate (OR 1.57 CI: 1.06, 2.31) and low opportunity (OR 2.34 CI: 1.64, 3.35) areas compared to high opportunity areas. State normalized COI 3.0 showed higher odds of reporting HRSNs in low opportunity areas only (OR: 1.87 CI: 1.08, 3.27). There was no significant association between HRSNs and COI 2.0 nor the Metropolitan normalized COI 3.0.</p><p><strong>Conclusions: </strong>The COI provides context in which individuals live, however, it is a poor proxy for individual HRSNs. Improvements were seen from COI 2.0 to 3.0, highlighting that continued updates to indices are important.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200169"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985343","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":"Language Development in Preschool Children Living with Chronic Health Conditions: A Cohort Study.","authors":"Thea Cameron-Faulkner, Leah Ward, Chen Zhao","doi":"10.1016/j.jpedcp.2025.200168","DOIUrl":"10.1016/j.jpedcp.2025.200168","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether the presence of childhood chronic conditions affect the early stages of language development.</p><p><strong>Study design: </strong>The study is based on data of three-year-old (n = 8821) and five-year-old (n = 8564) children from the Growing Up in Ireland longitudinal cohort study. A series of multilinear regression models were used to analyze the contribution of child health on caregiver perception of language development and children's vocabulary development.</p><p><strong>Results: </strong>A negative association between childhood chronic health and language development was identified at age 3 and age 5 when caregiver report measures were used, and at age 5 when standardized vocabulary scores were used. Teacher assessment mirrored these findings.</p><p><strong>Conclusions: </strong>Childhood chronic health conditions correlate negatively with language development and this relationship is apparent from the age of 3. In order to avoid subsequent issues at school entry age and beyond and also to ensure that children can take an active role in therapeutic communication with their health care teams, it is important to monitor and intervene when necessary. The findings also promote the use of caregiver report when ascertaining the relationship between childhood health and language development in young children.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200168"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985412","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 Quality Improvement Intervention for the Initial Care of Pediatric Septic Shock in a Resource-Limited Setting.","authors":"Suwannee Phumeetham, Kawewan Limprayoon, Suvikrom Law, Nutnicha Preeprem, Worapant Kriengsoontornkij","doi":"10.1016/j.jpedcp.2025.200170","DOIUrl":"10.1016/j.jpedcp.2025.200170","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of a quality improvement protocol-driven bundle care approach in reducing 28-day mortality among children with septic shock in a resource-limited setting.</p><p><strong>Study design: </strong>We conducted a retrospective-prospective observational study in a pediatric intensive care unit from January 2013 to August 2023. Clinical data were collected during the preprotocol and postprotocol periods. The primary outcome was 28-day mortality. The impact of a protocol-driven bundle care approach on 28-day mortality was assessed using multivariate logistic regression analysis.</p><p><strong>Results: </strong>We studied 163 patients: 94 in the preprotocol period and 69 in the postprotocol period. The median age was 8.5 years (IQR 1.9-13.5), and the median Pediatric Risk of Mortality, version III (PRISM-III) score was 11 (IQR 5-18). After protocol implementation, 28-day mortality significantly decreased from 32.9% to 11.6% (<i>P</i> = .002). There was no difference in illness severity between the groups. Multivariate logistic regression analysis revealed that patients cared for in the postintervention period had a significantly decreased risk of 28-day mortality (aOR 0.258, 95% CI 0.086-0.770, <i>P</i> = .015). However, higher PRISM-III scores were independently associated with increased mortality (aOR 1.193, 95% CI 1.115-1.277, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Implementing a quality improvement protocol-driven bundle care approach in a resource-limited pediatric setting was independently associated with a reduction in 28-day mortality among children with septic shock. These findings support the adoption of evidence-based protocols to improve outcomes in environments with limited resources. The strong correlation between PRISM-III scores and mortality highlights the importance of early recognition and planning for effective, timely intervention, and resource allocation.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200170"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985375","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":"Quantifying and Contextualizing Radiation Doses in Common Pediatric Medical Imaging Examinations.","authors":"Carly Stewart, Susan Alber, Malini Mahendra, Cameron Kofler, Trung Tran, Sean Domal, Erin J A Bowles, Sheila Weinmann, Robert T Greenlee, Natasha K Stout, Priscila Pequeno, Lisa M Moy, James R Duncan, Jason D Pole, Wesley E Bolch, Marilyn L Kwan, Diana L Miglioretti, Rebecca Smith-Bindman","doi":"10.1016/j.jpedcp.2025.200166","DOIUrl":"10.1016/j.jpedcp.2025.200166","url":null,"abstract":"<p><strong>Objective: </strong>To provide organ and effective radiation doses for common pediatric imaging examinations, which may help clinicians understand site-specific cancer risk, compare exposure across imaging modalities, and make informed care decisions.</p><p><strong>Study design: </strong>Within a large multicenter retrospective cohort, imaging utilization and associated radiation doses were estimated for children enrolled from birth into one of six US health care systems. Doses are described for examinations performed from 2012 to 2017. For computed tomography (CT), doses were estimated using examination-level technical parameters, patient height and weight, and Monte Carlo simulations. For fluoroscopy, angiography, nuclear medicine, and radiography, dose maps were developed by patient age, sex, size, and year through Monte Carlo simulations using technical parameters collected from patient examinations. The mean dose and standard deviation (SD) were calculated for each examination type, and each modality's contribution to the cohort's cumulative effective dose was calculated.</p><p><strong>Results: </strong>Eight hundred thirty-five thousand six hundred forty-three imaging examinations in 278 909 patients are included. Radiographs were the most commonly performed exam but made up 6% of radiation dose exposure. CT exams made up 4% of imaging exams but accounted for 80% of exposure. Head CT was the most common CT exam (44% of all CT). For head CT, the average radiation dose to the bone marrow (associated with hematologic cancer risk) was 9.8 mGy (SD = 6.7) and to the brain (associated with brain cancer risk) was 39 mGy (SD = 14.8).</p><p><strong>Conclusions: </strong>CT radiation doses to the bone marrow and brain fell within ranges associated with increased hematologic and brain cancer risk, and are highest in the youngest children.Keywords: Organ dose; effective dose; pediatric imaging; pediatric radiology; computed tomography; fluoroscopy; angiography; nuclear medicine; radiography; x-ray.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200166"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877778","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":"Skeletal Muscle Mass Measured Noninvasively by D₃-Creatine Dilution in Children and Term Infants.","authors":"Mahalakshmi Shankaran, Brian Scottoline, Faryal Imam, Kelly Garton, Jacob Lohr, Edna Nyangau, Hussein Mohammed, Marc Hellerstein, William J Evans","doi":"10.1016/j.jpedcp.2025.200158","DOIUrl":"10.1016/j.jpedcp.2025.200158","url":null,"abstract":"<p><strong>Objective: </strong>To measure the longitudinal changes in body composition including muscle mass (MM), total body water (TBW), and body fat in term infants and children using the D₃Creatine (D₃Cr) dilution method combined with ²H₂O.</p><p><strong>Study design: </strong>A total of 36 term infants were enrolled and measured at baseline and after 6 and 12 months. In addition, 30 boys (ages 4-12 years) and 31 girls (ages 4-10 years) were enrolled. A single dose of D₃Cr in 20% ²H₂O was administered orally using a syringe. Saliva and urine samples were used to determine ²H₂O and D₃Cr D₃creatinine enrichments for determination of TBW (fat-free mass [FFM]) and MM, respectively.</p><p><strong>Results: </strong>Body weight (BW), MM, and FFM were associated with age and increased longitudinally over 1 year in 21 boys and girls. In infants, MM increased by 256% after 1 year while %MM (MM/BW) remained constant at 26% after 6 months and increased to 36% after 1 year. Positive relationships were found between MM, TBW, BW, and anthropometric values.</p><p><strong>Conclusions: </strong>D₃Cr dilution provides a noninvasive measurement of MM in infants and children and when coupled with the measurement of TBW, a full body composition assessment is possible including MM, FFM, and body fat.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200158"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240766","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 Between Prenatal Cannabis Exposure and Child Health Care Use: A Retrospective Cohort Study in Ontario, Canada.","authors":"Gabrielle Pratt Tremblay, Arum Han, Ewa Sucha, Helen Hsu, Jessy Donelle, Daniel J Corsi","doi":"10.1016/j.jpedcp.2025.200151","DOIUrl":"10.1016/j.jpedcp.2025.200151","url":null,"abstract":"<p><strong>Objective: </strong>Cannabis use among expectant mothers has increased steadily over the past two decades. We compared the long-term health services use of offspring prenatally exposed to cannabis to that of matched, unexposed offspring.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study using linked perinatal and health administrative databases of all live, singleton births in Ontario, Canada hospitals between April 1, 2007 and March 31, 2012. Infants were followed until March 31, 2017, with a primary outcome of primary care visits up to age 10. Secondary outcomes included rates of outpatient psychiatrist visits, emergency department visits and hospitalizations. We used adjusted Poisson regression to assess differences in rates of health service use between children with and without exposure to prenatal cannabis.</p><p><strong>Results: </strong>We included 508 025 infants, 3248 (0.6%) had cannabis exposure. Prenatal cannabis use was associated with a decreased rate of primary care physician visits (adjusted rate ratio [aRR]: 0.86, 95% confidence interval [CI]: 0.84-0.87) and an increase in the rate of outpatient psychiatrist visits (aRR: 1.29, 95% CI: 1.00-1.66), emergency department visits (aRR: 1.05, 95% CI: 1.03-1.08), and hospitalizations (aRR: 1.12, 95% CI: 1.04-1.20). Among preterm offspring, cannabis was associated with a decrease in primary care visits but no difference in other visits. Among those in the highest income quintiles, cannabis use was associated with a two-fold increase in the rate of outpatient psychiatrist visits.</p><p><strong>Conclusions: </strong>Offspring exposed to prenatal cannabis receive fewer primary care visits but have increased rates of visiting health care specialists past the neonatal period.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200151"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532574","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":"Do Medicaid Data Accurately Reflect the Expenditures and Outcomes for Extremely Premature Infants?","authors":"Elenir B C Avritscher, Jon E Tyson, Therese A Stukel, Youngran Kim, Cecilia Ganduglia Cazaban, Kanekal S Gautham, David Lynch, David C Goodman","doi":"10.1016/j.jpedcp.2025.200150","DOIUrl":"10.1016/j.jpedcp.2025.200150","url":null,"abstract":"<p><p>The accurate and meaningful assessment of Medicaid expenditures relative to survival rates among Medicaid-eligible extremely premature infants has received little scrutiny, despite its importance for improving outcomes. We have identified key problems that hindered such assessments using Texas Medicaid data, which may also be relevant to other states.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"17 ","pages":"200150"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556419","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":"Parent and Family Well-Being and Associated Risk Factors as Children with Neonatal Seizures Reach Preschool and School-Age: A Longitudinal Cohort Study.","authors":"Linda S Franck, Monica E Lemmon, Lisa Grossbauer, Kamil Pawlowski, Julie S Sturza, Courtney J Wusthoff, Shavonne L Massey, Catherine J Chu, Janet S Soul, Adam L Numis, Cameron Thomas, Giulia M Benedetti, Tayyba Anwar, Madison M Berl, Jennifer C Gidley Larson, Elizabeth E Rogers, Carmen Chen, Charles E McCulloch, Hannah C Glass, Renée A Shellhaas","doi":"10.1016/j.jpedcp.2025.200149","DOIUrl":"10.1016/j.jpedcp.2025.200149","url":null,"abstract":"<p><strong>Objective: </strong>To assess parent/family well-being when children with neonatal seizures reach 3-8 years of age and examine factors associated with parent/family well-being.</p><p><strong>Methods: </strong>One parent per surviving infant in the Neonatal Seizure Registry-II was invited to complete validated surveys annually when children were between 3 and 8 years of age. Three outcomes were examined: (1) parent well-being (anxiety, depression, and quality of life); (2) parent post-traumatic stress symptoms; and (3) impact on the family. We used mixed model regression with random intercepts and guided backward elimination and included potential predictors that had bivariate associations <i>P</i> < .10 in the multivariable analyses.</p><p><strong>Results: </strong>Among 169 parents, 8%-35% experienced symptoms of anxiety, depression, or post-traumatic stress. When children were 8 years of age, about 1 in 3 parents had moderate to severe anxiety symptoms, approximately double the general population, 1 in 5 had post-traumatic stress disorder symptoms and depression symptom frequency was similar to the general population in the final models, only child social communication impairment was associated with poorer parental well-being or post-traumatic stress symptoms. Several child factors, including age at discharge from the neonatal admission, functional impairment at 24 months, social communication impairment, and receiving special services, were associated with greater impact on the family.</p><p><strong>Conclusions: </strong>Child social and functional health challenges following neonatal seizures were associated with poorer parent and family well-being across the preschool and early school years. Longitudinal screening of child social functioning, parent well-being, and family function is indicated for early detection and referral to treatment services.</p><p><strong>Trial registration: </strong>Clinical Trial Registration:NCT04337697.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"16 ","pages":"200149"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288097","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":"\"Open Notes\" in Pediatric Acute Care Cardiology: Caregiver and Provider Experiences in a Single Center.","authors":"Megan Rodts, Dana B Gal, Brittney K Hills, Elisa Marcuccio, Colleen M Pater, Samuel Hanke","doi":"10.1016/j.jpedcp.2025.200147","DOIUrl":"10.1016/j.jpedcp.2025.200147","url":null,"abstract":"<p><strong>Objective: </strong>To identify the utilization of shared medical notes, referred to as \"open notes,\" and the experience of caregivers and cardiology providers during inpatient hospitalization for congenital heart disease.</p><p><strong>Study design: </strong>Single-center, cross-sectional, survey-based study utilizing convenience sampling of patient caregivers on a pediatric acute care cardiology unit and corresponding cardiology providers. Surveys assessed demographic information, health literacy of caregivers, and experiences during inpatient hospitalization that relate to open note use. Descriptive statistics were performed.</p><p><strong>Results: </strong>Forty-five caregivers (47% of eligible) and 21 cardiology providers (100% of eligible) were enrolled. There were no demographic differences between caregivers, or their children, who were open notes vs nonopen notes users (<i>P</i> > .05). Most caregivers were aware that the notes were available (87%), yet fewer enrolled in the program to read them (71%). Most caregivers had positive experiences with the notes (85%), while cardiology providers' opinions were overall neutral or negative (65%). Cardiology providers' suggestions for improvement of open notes were frequently infeasible based on regulations required by the 21st Century Cures Act.</p><p><strong>Conclusions: </strong>Open notes in inpatient subspecialty pediatrics yields a novel opportunity for caregivers to engage positively and actively with the care team. Cardiology providers may value how positively caregivers view open notes as a method of receiving medical information and interacting with the care team. Cardiology providers may also benefit from further education on the new legislation in the 21st Century Cures Act.</p>","PeriodicalId":519930,"journal":{"name":"Journal of pediatrics. Clinical practice","volume":"16 ","pages":"200147"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304235","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}