Journal of Pediatrics最新文献

{"title":"Exception from Informed Consent in Neonatal Research","authors":"Jay R. Malone MD, PhD , Elizabeth E. Foglia MD, MSCE , Brian S. Carter MD , Sindhu Srinivas MD, MSCE , F. Sessions Cole MD","doi":"10.1016/j.jpeds.2026.114999","DOIUrl":"10.1016/j.jpeds.2026.114999","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"293 ","pages":"Article 114999"},"PeriodicalIF":3.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of Ultrasound-Assisted Versus Traditional Landmark Lumbar Puncture in the Neonatal and Infant Population.","authors":"Osayame A Ekhaguere, Russell Kesman, Joseph Reiter, María Victoria Fraga, Jason Z Stoller","doi":"10.1016/j.jpeds.2026.115139","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115139","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether static ultrasound improves first-attempt, non-traumatic lumbar puncture (LP) success compared with the traditional landmark technique in infants admitted to a neonatal intensive care unit (NICU).</p><p><strong>Study design: </strong>We conducted a prospective, randomized controlled trial at a single tertiary-care NICU between August 2016 and January 2020. Infants ≤6 months of age requiring LP were randomized 1:1 to ultrasound-assisted or traditional landmark LP. The primary outcome was first-attempt, non-traumatic LP success. Secondary outcomes included success within 2 attempts, procedure duration, and antibiotic exposure. Recruitment was terminated early due to the COVID-19 pandemic.</p><p><strong>Results: </strong>We analyzed 95 LPs performed in 91 infants by 16 proceduralists. First-attempt non-traumatic success occurred in 50% of LPs in both groups (odds ratio, 1.00; 95% CI, 0.41-2.43; P = 1.00). Other procedural success outcomes did not differ between groups. Procedure time was longer in the ultrasound group (mean 25.9 vs 17.9 minutes; P = 0.002). Median antibiotic duration was similar (8 days in both groups; p = 0.74). Ultrasound assistance improved success within 2 attempts among less experienced proceduralists, with diminishing benefit as LP experience increased. Operator ultrasound experience also modified effectiveness, with improved success observed among proceduralists with prior ultrasound exposure.</p><p><strong>Conclusions: </strong>Ultrasound assistance did not improve first-attempt non-traumatic LP success compared with the traditional landmark technique in NICU infants. Ultrasound assistance may improve success within 2 attempts among less experienced proceduralists, with effectiveness influenced by both LP and ultrasound experience.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115139"},"PeriodicalIF":3.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory Readmissions in First 3 Years of Life for Children with Bronchopulmonary Dysplasia.","authors":"Gangaram G Akangire, Joseph M Collaco, Anita Bhandari, Jessica L Rice, Nicole Stephenson, Sharon A McGrath-Morrow, Winston Manimtim","doi":"10.1016/j.jpeds.2026.115140","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115140","url":null,"abstract":"<p><strong>Objective: </strong>To examine the demographic, clinical, and environmental characteristics of children with bronchopulmonary dysplasia (BPD) associated with respiratory readmissions.</p><p><strong>Study design: </strong>Demographic and clinical data were obtained from children with BPD recruited from 15 centers participating in the BPD Collaborative between 2018 and 2025. Subjects with any hospital readmission for respiratory reasons were compared with children not readmitted as assessed by questionnaires obtained at clinic visits during the first 3 years of life. Clustered regression models were used to identify variables associated with readmission. Secondary analyses were performed to identify factors associated with a higher number (≥2) of readmissions.</p><p><strong>Results: </strong>There were 1615 participants who met inclusion criteria with a mean age of 9.4+ 7.5 months at recruitment. During the study period, 352 (21.8%) had at least 1 readmission and 1263 had no reported readmission. In multivariable models, an increased likelihood of readmission was associated with a shorter initial NICU hospitalization, use of a home ventilator, prescription of reflux medications, daycare attendance, and lower BPD control score.</p><p><strong>Conclusions: </strong>In young children with BPD, markers of medical complexity, such as home ventilator use for chronic respiratory failure and gastroesophageal reflux, were associated with a high likelihood of respiratory readmissions. Other potentially modifiable factors associated with readmissions include daycare attendance and respiratory symptom control. BPD severity was not associated with readmission risk. Identifying risk factors for respiratory readmission in the outpatient setting will help healthcare providers to provide targeted anticipatory guidance.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115140"},"PeriodicalIF":3.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed Contacts: Rethinking the Language of \"No-Show\" in Pediatric Care.","authors":"Brittany L Willer, Helen H Lee","doi":"10.1016/j.jpeds.2026.115138","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115138","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115138"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Surgical Management of Preterm Intraventricular Hemorrhage in North America.","authors":"Mandeep S Tamber, Hailey Jensen, John Kestle","doi":"10.1016/j.jpeds.2026.115141","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115141","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate current surgical approaches to the management of preterm intraventricular hemorrhage (IVH) in North America.</p><p><strong>Study design: </strong>This prospective North American observational cohort included 700 infants with preterm IVH who underwent neurosurgical evaluation. Patient characteristics were summarized at the time of initial consultation, the time of a temporizing and/or permanent cerebrospinal fluid (CSF) diversionary procedure, and the time of discharge from neurosurgical care.</p><p><strong>Results: </strong>Despite severe ventriculomegaly, a relative absence of signs of elevated intracranial pressure led to the initiation of an observational approach in 68% of the cohort. Surgical temporization occurred in 45%, generally prompted by the presence or emergence of signs of elevated intracranial pressure. Overall, permanent CSF diversion was required in 67%. Significant center variation in the proportion of infants undergoing temporary and permanent CSF diversion suggested heterogeneity in surgical decision making at these important timepoints.</p><p><strong>Conclusions: </strong>Surgical temporization for preterm IVH was generally considered in the presence of signs of elevated intracranial pressure when ventricles are significantly dilated. Center-based heterogeneity in decision making at key timepoints represents an important opportunity for evidence-based standardization of care.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115141"},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic Metaphyseal Dense Bands After Chronic Dietary Heavy Metal Exposure in Twin Toddlers.","authors":"Shao-Yen Wu, Yi-Jung Chen","doi":"10.1016/j.jpeds.2026.115143","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115143","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115143"},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticipatory Guidance for Discontinuation of Gender-Affirming Hormonal Care in Adolescent Patients.","authors":"Abby Walch, Adrian Araya, Kara Connelly, Jax Whitehead, Stephanie A Roberts","doi":"10.1016/j.jpeds.2026.115145","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115145","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115145"},"PeriodicalIF":3.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerated Weaning of Opioids to Reduce Pharmacologic Exposure for Neonatal Opioid Withdrawal Syndrome: A Randomized Clinical Trial","authors":"Abbot R. Laptook MD ,&nbsp;Adam Czynski DO ,&nbsp;Rouba Chahine PhD ,&nbsp;Rachel G. Greenberg MD MB MHS ,&nbsp;P. Brian Smith MD ,&nbsp;Erica Oliveira BA ,&nbsp;Jenna Gabrio MPH ,&nbsp;Barry Eggleston MS ,&nbsp;Abhik Das PhD ,&nbsp;Jeannette Lee PhD ,&nbsp;Barry Lester PhD ,&nbsp;Dave Clark DrPH, MPH ,&nbsp;Michele Walsh MD ,&nbsp;Helen Ko MD ,&nbsp;Clare Campbell Asher MD ,&nbsp;Hayley Friedman MD ,&nbsp;Samuel Gentle MD ,&nbsp;Karishma Rao MD ,&nbsp;Anup Katheria MD ,&nbsp;Kristen Benninger MD ,&nbsp;Jessica Snowden MD","doi":"10.1016/j.jpeds.2026.114992","DOIUrl":"10.1016/j.jpeds.2026.114992","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if newborns receiving morphine or methadone as the primary pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) tolerate and receive fewer days of opioid using an accelerated wean protocol (15% decrements) compared with using a slower wean protocol (10% decrements).</div></div><div><h3>Study design</h3><div>Newborns ≥36 weeks of gestation receiving morphine or methadone for NOWS were enrolled in a pragmatic blinded, randomized multicenter trial. Newborns underwent protocol-driven weaning with decreasing opioid doses of either 15% or 10% decrements. Weaning was encouraged every 24 hours, and if signs of NOWS worsened, the preceding dose was resumed. To maintain blinding, the last 3 dose levels of the 15% decrements were placebo. The primary outcome was the number of days of opioid treatment from the first weaning dose to cessation of opioids.</div></div><div><h3>Results</h3><div>Slow enrollment prompted early trial closure; 189 newborns were randomized, 98 (51.9%) to 15% decrements (mean ± SD, 38.8 ± 1.2 weeks gestation, 59.8% male) and 91 (48.1%) to 10% decrements (38.8 ± 1.3 weeks gestation, 61.5% male). Morphine was used most commonly. Intention-to-treat analysis included all but 4 infants withdrawn in the 15% decrement group. The durations of opioid treatment during weaning were 8.2 (7.2, 9.5) (adjusted mean [95% CI]) and 11.2 (9.7, 12.9) days for 15% and 10% decrement groups, respectively (<em>P</em> &lt; .001). Adverse events were few in both groups.</div></div><div><h3>Conclusion</h3><div>Pharmacologic treatment of NOWS using an accelerated wean protocol (15% decrements) was well tolerated with fewer days of opioid treatment compared with 10% decrements.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> number: NCT04214834</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"292 ","pages":"Article 114992"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incident Epilepsy and Vaccination Status or Vaccine Aluminum Exposure in Children Under Age 4","authors":"David L. McClure PhD ,&nbsp;Kayla E. Hanson MPH ,&nbsp;Maria E. Sundaram MSPH, PhD ,&nbsp;Burney A. Kieke MS ,&nbsp;Jonathan Duffy MD, MPH ,&nbsp;Michael M. McNeil MD, MPH ,&nbsp;Jason M. Glanz PhD ,&nbsp;Stephanie A. Irving MHS ,&nbsp;Joshua T.B. Williams MD ,&nbsp;Elyse O. Kharbanda MD, MPH ,&nbsp;Stanley Xu PhD ,&nbsp;Ousseny Zerbo PhD ,&nbsp;Jennifer C. Nelson PhD ,&nbsp;Edward A. Belongia MD ,&nbsp;Eric S. Weintraub MPH","doi":"10.1016/j.jpeds.2026.115004","DOIUrl":"10.1016/j.jpeds.2026.115004","url":null,"abstract":"<div><h3>Objective</h3><div>To assess any potential associations between epilepsy and up-to-date (UTD) vaccination status or cumulative aluminum exposures from vaccines among children aged less than 4 years.</div></div><div><h3>Study design</h3><div>We conducted a case-control study in the Vaccine Safety Datalink cohort from 2008 through 2018. Epilepsy cases were identified up to 4 years of age by diagnosis codes with accompanying by antiseizure medication prescriptions. Controls had no diagnosis codes for epilepsy/seizures and no antiseizure medication before 4 years of age. Each case was matched to up to 10 controls. Cases and controls were matched on birthdate, sex, and Vaccine Safety Datalink site. Th exposures were age-specific UTD vaccination status categories and continuous, cumulative aluminum content per adjuvant formulation from vaccination. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for the associated risk of epilepsy. Secondary analyses were performed by age subgroups and limited to children with epilepsy of unknown etiology.e</div></div><div><h3>Results</h3><div>The primary analysis included 2089 cases and 20 139 matched controls. No adjusted odds ratio for risk of epilepsy was greater than 1 either for UTD immunization status or for cumulative exposure to aluminum per mg increase per adjuvant formulation. In addition, there was no statistically significant relationship in analyses by age group or limitation to children with epilepsy of unknown etiology.</div></div><div><h3>Conclusions</h3><div>Incident epilepsy was not associated with UTD vaccination status or cumulative vaccine aluminum exposure among children aged less than 4 years.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"292 ","pages":"Article 115004"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing the Financial Divide: A Net Present Value Analysis of Lifetime Earnings in Academic versus Private Practice Neonatology","authors":"Ankita Shukla MD, PhD ,&nbsp;Amna Qasim MD ,&nbsp;Lubaina Ehsan MD ,&nbsp;Vikas Chowdhary MD ,&nbsp;Joshua Daily MD","doi":"10.1016/j.jpeds.2025.114843","DOIUrl":"10.1016/j.jpeds.2025.114843","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"292 ","pages":"Article 114843"},"PeriodicalIF":3.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}