Lancet Child & Adolescent Health最新文献

{"title":"Advances and challenges in childhood pneumonia","authors":"The Lancet Child & Adolescent Health","doi":"10.1016/S2352-4642(25)00162-2","DOIUrl":"10.1016/S2352-4642(25)00162-2","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Page 439"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of repeat epinephrine to inform paediatric anaphylaxis observation periods: a retrospective cohort study","authors":"Timothy E Dribin MD , Prof Hugh A Sampson MD , Yin Zhang MS , Stephanie Boyd PhD , Prof Nanhua Zhang PhD , Kenneth A Michelson MD , Prof Mark I Neuman MD , Prof David C Brousseau MD , Prof Rakesh D Mistry MD , Prof Stephen B Freedman MDCM , Prof Paul L Aronson MD , Kelly R Bergmann DO , Brittany Boswell MD , Sri S Chinta MBBS , Wee-Jhong Chua MD , Ari R Cohen MD , Joanna S Cohen MD , Alicia Daggett MD , Justin R Davis MD , Julia F Freeman MD , Seth Woolf","doi":"10.1016/S2352-4642(25)00139-7","DOIUrl":"10.1016/S2352-4642(25)00139-7","url":null,"abstract":"<div><h3>Background</h3><div>Children presenting to the emergency department with anaphylaxis typically receive at least one dose of epinephrine and are observed in the emergency department or monitored for recurrent (biphasic anaphylaxis) or persistent symptoms on hospital wards for variable durations before discharge is considered safe. We aimed to calculate the incidence rate and timing of repeat epinephrine dosing to determine the observation threshold at which the cumulative incidence of repeat epinephrine was less than 2% for every 1 h increase in observation time.</div></div><div><h3>Methods</h3><div>This multicentre, retrospective cohort study across 30 emergency departments in the USA and one emergency department in Canada included children aged 6 months to 17 years who, according to electronic medical records, presented to one of the participating emergency departments with an acute allergic reaction that was treated with intramuscular, subcutaneous, or intravenous epinephrine before arrival at the emergency department or in the emergency department between Jan 1, 2016, and Dec 31, 2019. We excluded patients who had no documentation of symptoms or examination findings before presenting to the emergency department, were transferred from outside health-care facilities, had reactions secondary to medications administered in the emergency department, or had comorbidities requiring tailored management decisions. Demographics, medical history, and emergency department revisits within 72 h of discharge were extracted from electronic medical records. The primary outcome was the time from first to last administration of epinephrine. For patients on intravenous epinephrine infusions, the relevant time interval was from infusion initiation to discontinuation. Kaplan–Meier analyses were used to compare time to last epinephrine dose by initial reaction severity, stratified by respiratory and cardiovascular involvement (no respiratory or cardiovascular involvement, respiratory but no cardiovascular involvement, and cardiovascular involvement).</div></div><div><h3>Findings</h3><div>Of 7717 patients with ICD-10 Clinical Modification codes for anaphylaxis, 5641 were eligible for inclusion (median age 7·9 years [IQR 3·3–13·1]; 2475 [43·9%] female; 3166 [56·1%] male). Of the 5139 patients who reported ethnicity, 1131 (22·0%) identified as Hispanic and 4008 (78·0%) identified as non-Hispanic. 263 (4·7%) of 5641 patients received a repeat epinephrine after 2 h of the first dose, whereas 109 (1·9%) received repeat epinephrine after 4 h, 64 (1·1%) after 6 h, and 46 (0·8%) after 8 h. The observation period at which the increase in cumulative incidence of repeat epinephrine was less than 2% was 115 min (95% CI 105–122) for all patients, 105 min (54–135) for patients without respiratory or cardiovascular involvement (n=1070), 109 min (98–118) for patients with respiratory but no cardiovascular involvement (n=4076), and 161 min (125–249) for patients with cardiov","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 484-496"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, co-occurring psychiatric conditions, and sex differences in young people without intellectual impairment who are autistic, ADHD, or autistic–ADHD: a population-based cross-sectional study in Iceland","authors":"Kristin Ros Sigurdardottir MS , Dagmar Kr Hannesdottir PhD , Berglind Hauksdottir MS , Prof Thomas H Ollendick PhD , Katrin Davidsdottir MD , Thorhildur Halldorsdottir PhD","doi":"10.1016/S2352-4642(25)00132-4","DOIUrl":"10.1016/S2352-4642(25)00132-4","url":null,"abstract":"<div><h3>Background</h3><div>Population-based studies comparing the incidence and co-occurring psychiatric conditions of young people without intellectual impairment who are autistic, Attention-Deficit/Hyperactivity Disorder (ADHD), or autistic–ADHD are scarce. For autistic, ADHD, and autistic–ADHD youth in Iceland aged 7–18 years without intellectual impairment, we aimed primarily to estimate the age-standardised incidence of these 3 neurotypes, overall and by sex, and secondarily to estimate the prevalence of co-occurring psychiatric conditions and emotional and conduct challenges.</div></div><div><h3>Methods</h3><div>In this nationwide, population-based cross-sectional study we included young people without intellectual impairment aged 7–18 years who were autistic, ADHD, or autistic–ADHD. Children were referred to the Centre for Child Development and Behaviour in Reykjavik, Iceland, through a structured pre-assessment process during which caregivers completed a validated screening battery on the child's behavioural, emotional, and developmental characteristics. Trained clinicians administered gold-standard clinical assessment procedures to assess autism, ADHD, and co-occurring psychiatric presentations. Caregiver-reported and teacher-reported emotional and conduct challenges were measured with the Strengths and Difficulties Questionnaire. ICD-10 condition classification was determined during consensus meetings with clinical psychologists and a paediatrician. Age-standardised prevalence and incidence rates were calculated.</div></div><div><h3>Findings</h3><div>Between Feb 11, 2013, and Dec 20, 2021, 2034 children age 7–18 years without intellectual impairment (728 females and 1306 males; mean age 10·93 [SD 2·82]) were recognised as autistic (n=229), ADHD (n=1428), or autistic–ADHD (n=377) in Iceland. Age-standardised incidence rates were 126 per 100 000 person-years (95% CI 116–137) for all autistic young people (ie, autistic and autistic–ADHD) and 374 per 100 000 person-years (357–392) for all young people with ADHD (ie, ADHD and autistic–ADHD). By neurotype groups, the incidence per 100 000 person-years was 48 (95% CI 42–54) for autism, 78 (71–87) for autism–ADHD, and 295 (280–311) for ADHD. Incidence was lower in females than males for all three neurotypes: incidence rate ratio 0·53 (95% CI 0·40–0·69) for autistic young people, 0·43 (0·35–0·54) for autistic–ADHD young people, and 0·64 (0·57–0·71) for ADHD young people.</div></div><div><h3>Interpretation</h3><div>This study provides robust, population-based estimates of the incidence of autistic, ADHD, and autistic–ADHD young people without intellectual impairment. The higher incidence of autistic–ADHD young people compared with autistic alone underscores the common co-occurrence of ADHD in autistic young people—a pattern that might have been underrepresented in previous literature.</div></div><div><h3>Funding</h3><div>None.</div></div><div><h3>Translation</h3><div>For the Icelandic translati","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 459-469"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resolved anaphylaxis in the emergency department: should I stay or should I go?","authors":"Marcus Shaker","doi":"10.1016/S2352-4642(25)00159-2","DOIUrl":"10.1016/S2352-4642(25)00159-2","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 441-442"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing paediatric cancer care in Jordan: a strategic 10-year roadmap","authors":"Rawad Rihani MD MSc ,&nbsp;Abdalla Awidi MD ,&nbsp;Maha Barbar MD ,&nbsp;Maher Mustafa MD ,&nbsp;Laila Tutunji MD ,&nbsp;Yaser Rayyan MD ,&nbsp;Asem Mansour MD ,&nbsp;Hikmat Abdel-Razeq MD ,&nbsp;Iyad Sultan MD","doi":"10.1016/S2352-4642(25)00103-8","DOIUrl":"10.1016/S2352-4642(25)00103-8","url":null,"abstract":"<div><div>In this Review, we assess the current landscape of paediatric cancer care in Jordan, identifying crucial gaps, barriers, and challenges in delivering optimal paediatric cancer services, and propose targeted, actionable solutions. We outline a comprehensive 10-year roadmap for advancing paediatric cancer care in Jordan, which was developed by national experts in paediatric oncology and public health. The roadmap emphasises a holistic, patient-centred approach that prioritises equitable, accessible, and high-quality care for children. Spanning the entire cancer care continuum, from early detection and diagnosis to treatment, survivorship, and palliative care, the roadmap emphasises psychosocial support for families. Key priorities include capacity building, standardised treatment regimens, and evidence-based practices, as well as community engagement to promote cancer awareness and reduce stigma. In this roadmap, we also highlight the need for innovative therapies, expanded research capacity, and workforce development to address the unique needs of children with cancer. A proposed consensus-driven monitoring system will ensure sustainable implementation and progress in paediatric oncology services in Jordan.</div></div><div><h3>Translation</h3><div>For the Arabic translation of the abstract see Supplementary Materials section.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 497-507"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Child Adolesc Health 2025; 9: 383–92","authors":"","doi":"10.1016/S2352-4642(25)00164-6","DOIUrl":"10.1016/S2352-4642(25)00164-6","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Page e15"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Youth-less research","authors":"Annabelle E Prescott,&nbsp;Sarah E Hetrick","doi":"10.1016/S2352-4642(25)00161-0","DOIUrl":"10.1016/S2352-4642(25)00161-0","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 448-449"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of polyarticular juvenile idiopathic arthritis in Latin America: recommendations from the Pan-American League of Associations for Rheumatology","authors":"Raúl Gutiérrez-Suárez MD MSc ,&nbsp;Prof Simone Appenzeller PhD ,&nbsp;Prof Clovis Artur Silva MD ,&nbsp;Adriana Rodrigues Fonseca PhD ,&nbsp;Zoilo Morel MD ,&nbsp;Ruth Eraso MD ,&nbsp;Lorena Franco MD ,&nbsp;Rubén J Cuttica MD ,&nbsp;Manuel Alberto Ferrándiz Zavaler MD ,&nbsp;Karen Viviana Jiménez Cruz MD ,&nbsp;María L Barzola MD ,&nbsp;Eduardo Talesnik MD ,&nbsp;Enrique Faugier Fuentes MD ,&nbsp;Amparo Ibañez Estrella MD ,&nbsp;Rosario M Jurado MD ,&nbsp;Ivonne L Arroyo Rivera MD ,&nbsp;Pilar Guarnizo Zuccardi MD ,&nbsp;Beatriz H León Nogués MD ,&nbsp;Carmen Rodriguez Tineo MD ,&nbsp;Cristina N Herrera MD ,&nbsp;Graciela Espada MD","doi":"10.1016/S2352-4642(25)00122-1","DOIUrl":"10.1016/S2352-4642(25)00122-1","url":null,"abstract":"<div><div>To develop evidence-based treatment guidelines for non-systemic polyarticular-juvenile idiopathic arthritis (poly-JIA) in Latin America, endorsed by the Pan-American League of Associations for Rheumatology (PANLAR), a panel of paediatric rheumatologists from Latin America formulated clinically relevant questions regarding polyarthritis treatment, using the Population, Intervention, Comparator, and Outcome (PICO) format. Following the Grading of Recommendations Assessment, Development, and Evaluation methodology, a team of methodologists conducted a systematic literature review, extracted and summarised intervention effect estimates, and assessed the quality of evidence. The panel of paediatric rheumatologists voted on each PICO question and formulated recommendations, requiring a consensus of at least 70% amongst the voting members. Eight recommendations and one expert opinion statement were developed. For newly diagnosed poly-JIA or those with minimal disease activity, the use of non-steroidal anti-inflammatory drugs as adjuvant therapy, along with a non-biological disease-modifying antirheumatic drug (nbDMARD) is recommended. For children and young people achieving an inactive disease state, continuation of nbDMARD treatment for at least 12 months post-remission is advised. In cases of methotrexate intolerance, contraindications, limited availability, or non-response, leflunomide could be used as an alternative. For children and young people with high disease activity or poor prognostic factors, the addition of a biological disease-modifying antirheumatic drug (bDMARD) is recommended. Triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine can be considered when bDMARDs are not available. Low-dose, short-term corticosteroid use is also recommended. The first PANLAR poly-JIA treatment guidelines offer evidence-based recommendations to support health-care providers in the management of poly-JIA in Latin America.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 508-518"},"PeriodicalIF":19.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Listen to the parents: caregiver concern and development of critical illness","authors":"Asya Agulnik","doi":"10.1016/S2352-4642(25)00141-5","DOIUrl":"10.1016/S2352-4642(25)00141-5","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 440-441"},"PeriodicalIF":19.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study","authors":"Erin Mills MBBS ,&nbsp;Phyllis Lin MSBA ,&nbsp;Mohammad Asghari-Jafarabadi MSc ,&nbsp;Adam West MBBS ,&nbsp;Prof Simon Craig MBBS","doi":"10.1016/S2352-4642(25)00098-7","DOIUrl":"10.1016/S2352-4642(25)00098-7","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In high-income countries, critical illness in children is rare, and often difficult for physicians to distinguish from common minor illness until late in the disease. Parents or caregivers are well positioned to detect early and subtle signs of deterioration, but the relationship between their concerns and patient outcomes is unknown. We aimed to examine the relationship between documented caregiver concern about clinical deterioration and critical illness in children presenting to hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This prospective observational cohort study was conducted in the tertiary paediatric emergency department and inpatient paediatric wards at Monash Children's Hospital, Melbourne, Australia. We included patients younger than 19 years with a complete medical record, with a documented response to the question “Are you worried your child is getting worse?” asked to caregivers during their child's emergency department visit or hospital admission. The primary objective of this study was to examine the relationship between caregiver concern for clinical deterioration and critical illness, defined as intensive care unit admission, in paediatric patients presenting to hospital. Secondary objectives were to determine the relationship between caregiver concern for clinical deterioration and mechanical ventilation or death of the child, and to compare documented caregiver concern for deterioration with standard predictors of deterioration, such as abnormal vital signs. Multivariable analysis assessed whether caregiver concern for clinical deterioration was associated with intensive care unit (ICU) admission, mechanical ventilation, or death for all included patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;In 26 months, from Nov 1, 2020 to Dec 31, 2022, 79 166 children younger than 19 years presented to the emergency department. 433 children were excluded due to transfer to a different hospital and 4888 were excluded as there were no sets of vital signs recorded after triage. Of the remaining 73 845 children with eligible emergency department presentations, 24 239 had at least one documented response for parent or caregiver concern (11 431 [47·2%] males and 12 808 [52·8%]) females). There were a total of 189 708 responses, and 8937 (4·7%) of these indicated concern for clinical deterioration. Compared with patients with caregivers without documented concerns, those with a caregiver reporting concern for clinical deterioration were more likely to be admitted to the ICU (6·9% [326/4721] &lt;em&gt;vs&lt;/em&gt; 1·8% [352 of 19 518]), to be mechanically ventilated (1·1% [53 of 4721] &lt;em&gt;vs&lt;/em&gt; 0·2% [48 of 19 518]), or die during admission (0·1% [five of 4721] &lt;em&gt;vs&lt;/em&gt; 0·02% [four of 19 518]). Multivariable analysis showed caregiver concern for clinical deterioration was associated with ICU admission (adjusted odds ratio [aOR] 1·72 (1·40–2·11) and mechanical ventilation (aOR 1·85 (1·36–3·15), but not death (aOR 1·02 (0·1","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 7","pages":"Pages 450-458"},"PeriodicalIF":19.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}