Journal of Pediatrics最新文献

{"title":"Executive Function Outcomes at School Age in Children Born Moderate-to-Late Preterm","authors":"Lauren Rossetti BPsych (Hons) ,&nbsp;Leona Pascoe PhD ,&nbsp;Rheanna M. Mainzer PhD ,&nbsp;Rachel Ellis PhD ,&nbsp;Joy E. Olsen PhD ,&nbsp;Alicia J. Spittle PhD ,&nbsp;Lex W. Doyle MD ,&nbsp;Jeanie L.Y. Cheong MD ,&nbsp;Peter J. Anderson PhD","doi":"10.1016/j.jpeds.2025.114634","DOIUrl":"10.1016/j.jpeds.2025.114634","url":null,"abstract":"<div><h3>Objective</h3><div>To compare executive function (EF) outcomes at school age between children born moderate-to-late preterm (MLP; 32-36 weeks' gestation) and term (≥37 weeks’ gestation) across subdomains of attentional control, cognitive flexibility, goal setting, and everyday executive behaviors.</div></div><div><h3>Study design</h3><div>Two hundred one children born MLP and 201 born at term were recruited from the Royal Women's Hospital, Melbourne, Australia. Children completed EF measures at 9 years of corrected age. Group differences in mean or median outcome z-scores were estimated using linear or quantile regression. EF impairment risk ratios [RRs] between groups were estimated using generalized linear models. Analyses were adjusted for multiple birth and social risk.</div></div><div><h3>Results</h3><div>One hundred fifty-nine children born MLP (79%) and 134 born at term (67%) were assessed. Compared with the term group, the MLP group performed poorer in goal setting (mean difference = −0.26, 95% CI = −0.50, −0.03, <em>P</em> = .03) and cognitive flexibility (mean difference = −0.32, 95% CI = −0.59, −0.05, <em>P</em> = .02). Children born MLP were at increased risk of behavioral executive dysfunction (RR = 1.86, 95% CI = 1.05, 3.27, <em>P</em> = .03), impairments in cognitive flexibility (RR = 1.80, 95% CI = 1.05, 3.09, <em>P</em> = .03), and goal setting (RR = 1.69, 95% CI = 1.08, 2.65, <em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>Children born MLP demonstrate a pattern of increased EF difficulties at school-age compared with term children, mostly within the goal setting subdomain. These difficulties are likely to affect other outcomes such as academic performance and social skills.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"284 ","pages":"Article 114634"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012988","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":"Accuracy of Home Blood Pressure Monitoring in Youth: A Systematic Review and Meta-Analysis","authors":"Victoria Cueto MD ,&nbsp;Hugh Medvecky BS ,&nbsp;Melissa C. Funaro MS, MLS ,&nbsp;James T. Nugent MD, MPH","doi":"10.1016/j.jpeds.2025.114633","DOIUrl":"10.1016/j.jpeds.2025.114633","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the accuracy of home blood pressure monitoring (HBPM) in youth compared with the reference standard of ambulatory BP monitoring (ABPM).</div></div><div><h3>Study design</h3><div>MEDLINE, Embase, Web of Science, and Cochrane Library were systematically searched from inception to November 13, 2024. Two authors identified studies testing the accuracy of HBPM compared with ABPM in youth ≤18 years. We assessed outcomes on the continuous scale (mean difference [MD]) or categorical scale (sensitivity, specificity, κ). We conducted a meta-analysis using hierarchical random effects weights.</div></div><div><h3>Results</h3><div>Of the 2966 titles screened, 26 studies were included (total n = 1992 patients, median 59 per study). Daytime home BP was lower than awake ambulatory BP (systolic MD, −6.4 mmHg [95% CI, −10.7 to −2.0]; diastolic MD, −3.3 mmHg [95% CI, −6.0 to −0.7]). Diagnosing daytime ambulatory hypertension by HBPM had modest sensitivity (0.52-0.64) and good specificity (0.82-0.97), with moderate agreement (κ 0.50-0.65). Accuracy was higher for white coat hypertension (sensitivity, 0.77-0.89; specificity, 0.85-0.94; κ, 0.66-0.73) and specificity was slightly higher for masked hypertension (sensitivity, 0.23-0.38; specificity, 0.92-0.96; κ, 0.27-0.36). Nocturnal home BP was higher than asleep ambulatory BP (systolic MD, 2.6-5.0 mmHg; diastolic MD, 2.2-3.2 mmHg) with moderate agreement (κ, 0.33-0.49). Limitations included different hypertension thresholds and HBPM protocols.</div></div><div><h3>Conclusions</h3><div>The accuracy of HBPM may not be sufficient to replace ABPM as a single test. However, HBPM may be a practical alternative when ABPM is not available, particularly when clinic and home BPs are concordant. Future work is needed to determine the best approach to HBPM in clinical practice.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"284 ","pages":"Article 114633"},"PeriodicalIF":3.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026073","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":"Feasibility of an Intervention to Support Shared Decision-Making for Critically Ill Infants","authors":"Monica E. Lemmon MD ,&nbsp;Simran Bansal ,&nbsp;Nikhita Nanduri ,&nbsp;Angel Davalos PhD ,&nbsp;Hannah C. Glass MD, MAS ,&nbsp;Blyth Lord ,&nbsp;Katrina Moline ,&nbsp;Betsy Pilon ,&nbsp;Rose Sharpe MSN, CPNP ,&nbsp;Debra Brandon PhD, RN, CCNS, FAAN ,&nbsp;Hwanhee Hong PhD ,&nbsp;Greg Samsa PhD ,&nbsp;Christopher E. Cox MD, MHA, MPH ,&nbsp;Kathryn I. Pollak PhD","doi":"10.1016/j.jpeds.2025.114632","DOIUrl":"10.1016/j.jpeds.2025.114632","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and pilot an intervention to support communication and decision-making for critically ill infants.</div></div><div><h3>Study design</h3><div>In this single-arm, mixed-methods, prospective, feasibility study, we enrolled infants, parents, and clinicians at a single tertiary care center. The Building Rapport, Improving Dialogue, and Growing Empathy intervention contains a values clarification exercise and question prompt list that parents can opt to share with the health care team. Parent and clinician participants completed surveys and semistructured interviews ≥72 hours postintervention. The primary outcome was intervention feasibility, defined as an enrollment rate ≥50% and a complete data collection rate ≥80%. Secondary outcomes included intervention acceptability and preparation for decision-making (Preparedness for Decision-Making Scale, score: 0-100, higher scores indicating higher preparedness). Statistical analyses were descriptive, and interviews were analyzed using a rapid-cycle qualitative approach.</div></div><div><h3>Results</h3><div>Thirty clinicians and 44 parents of 30 infants were enrolled (enrollment rate: 56%; complete data collection rate: 97%). The majority of parents and clinicians endorsed the tool as helpful, would recommend the tool to other parents, and would use the tool in the future. Preparedness for decision-making was high for both mothers (median score = 82, IQR: 70.0-90.0) and fathers (median score = 60, IQR: 38-74). Qualitative analysis of the intervention's impact identified 4 themes: (1) providing a scaffold; (2) validating and affirming experience; (3) preparing for a conversation; and (4) facilitating connection.</div></div><div><h3>Conclusions</h3><div>The Building Rapport, Improving Dialogue, and Growing Empathy intervention was feasible and acceptable to parents and clinicians. Future work should assess its impact on values-congruent decision-making, therapeutic alliance, and infant outcomes.</div></div><div><h3>Trial registration</h3><div><span><span>NCT05733975</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"283 ","pages":"Article 114632"},"PeriodicalIF":3.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996363","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":"The Association between Medical Debt and Food Insecurity among United States Families with Children","authors":"Elsa R. Treffeisen MD, MPH ,&nbsp;Rahela Aziz-Bose MD, MPH ,&nbsp;Anisha U. Gundewar MD ,&nbsp;Nour M. Hammad MSc, RDN ,&nbsp;Cindy W. Leung ScD, MPH","doi":"10.1016/j.jpeds.2025.114631","DOIUrl":"10.1016/j.jpeds.2025.114631","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the association between medical debt and food insecurity in a recent nationally representative sample of US families with children, and to assess whether family income or health insurance type modifies this association.</div></div><div><h3>Study design</h3><div>We conducted a cross-sectional study of US parents using the 2019-2023 National Health Interview Survey. Multivariable logistic regression models, adjusted for sociodemographic characteristics and survey year, assessed the association between medical debt, defined as self-reported inability to pay medical bills, and food insecurity. We tested for effect modification and conducted stratified analyses by the ratio of family income to the poverty threshold and by health insurance type.</div></div><div><h3>Results</h3><div>Among 29 260 parents, 7.9% experienced family medical debt and 8.8% reported family food insecurity. Families with medical debt had 4.04-fold odds of food insecurity (95% CI: 3.49, 4.67; <em>P &lt;</em> .001) compared with families without medical debt. This association was present across all income groups (<em>P &lt;</em> .001) and was modified by family income (<em>P</em>-interaction &lt;.001), with middle-income families (200%-399% federal poverty level) experiencing the strongest association (aOR: 6.91; 95% CI: 5.28, 9.05; <em>P &lt;</em> .001). Similarly, insurance type modified the association between medical debt and food insecurity (<em>P</em>-interaction 0.002), with families with a privately insured parent experiencing the strongest association (aOR 5.71; 95% CI 4.57, 7.13; <em>P &lt;</em> .001).</div></div><div><h3>Conclusion</h3><div>Medical debt is associated with increased odds of food insecurity among families with children. These consequences disproportionately impact middle-income and privately insured families, highlighting the importance of comprehensive policies to prevent and mitigate medical debt and food insecurity in pediatric settings.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"283 ","pages":"Article 114631"},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022466","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":"Pazopanib-Induced Zebra Hair Depigmentation","authors":"Benmario Castaldo MD,&nbsp;Alessandro Zago MD,&nbsp;Simone Ramazzotti MD,&nbsp;Samuele Naviglio MD,&nbsp;Egidio Barbi MD,&nbsp;Marco Rabusin MD","doi":"10.1016/j.jpeds.2025.114630","DOIUrl":"10.1016/j.jpeds.2025.114630","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"285 ","pages":"Article 114630"},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065057","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":"The Child Opportunity Index: Advancing Precision Social Medicine","authors":"Jonathan M. Gabbay MD ,&nbsp;Jennifer M. Perez MD ,&nbsp;Matt Hall PhD ,&nbsp;Robert J. Graham MD ,&nbsp;Clemens Noelke PhD, MA ,&nbsp;Dolores Acevedo-Garcia PhD, MPA-URP ,&nbsp;Kevin P. Fiori MD, MPH, MS","doi":"10.1016/j.jpeds.2025.114626","DOIUrl":"10.1016/j.jpeds.2025.114626","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"283 ","pages":"Article 114626"},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043659","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":"Reply.","authors":"Sarah E Messiah, Deepali K Ernest, Nestor de la Cruz-Muñoz, Steven E Lipshultz, Sarah E Barlow","doi":"10.1016/j.jpeds.2025.114616","DOIUrl":"10.1016/j.jpeds.2025.114616","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114616"},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Furosemide Safety in Preterm Infants at Risk for Bronchopulmonary Dysplasia: A Randomized Clinical Trial","authors":"Rachel G. Greenberg MD, MB, MHS ,&nbsp;Jason Lang MD, MPH ,&nbsp;P. Brian Smith MD, MPH, MHS ,&nbsp;Prem Shekhawat MBBS, MD ,&nbsp;Sherry E. Courtney MD ,&nbsp;Mark L. Hudak MD ,&nbsp;Fernando Moya MD ,&nbsp;Anjali Iyengar MD ,&nbsp;Alaa Eldemerdash MD ,&nbsp;Barry Bloom MD ,&nbsp;Mitzi Go MD, MCR ,&nbsp;Mina Hanna MD ,&nbsp;Lawrence Rhein MD, MPH ,&nbsp;Sofia Aliaga MD, MPH ,&nbsp;Tamorah Lewis MD, PhD ,&nbsp;Aprille Febre MD ,&nbsp;Autumn S. Kiefer MD ,&nbsp;Varsha Bhatt-Mehta PharmD, MS ,&nbsp;Joseph A. Khoury MD ,&nbsp;David Selewski MD ,&nbsp;Lawrence Taylor","doi":"10.1016/j.jpeds.2025.114629","DOIUrl":"10.1016/j.jpeds.2025.114629","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the safety of furosemide in preterm infants at the risk of developing bronchopulmonary dysplasia (BPD).</div></div><div><h3>Study design</h3><div>This multicenter, randomized, dose-escalating, placebo-controlled trial enrolled infants born &lt;29 weeks gestational age at 7-28 days postnatal age and at risk for BPD. Infants were randomized 3:1 (furosemide:placebo) into 2 cohorts with escalating doses of furosemide to a maximum of 1 mg/kg intravenous (IV; or 2 mg/kg enteral) every 24 hours (cohort 1; n = 40) or 1 mg/kg IV (or 2 mg/kg enteral) every 6 hours (cohort 2; n = 40) for 28 days. Effects of furosemide on total adverse events (AEs; primary outcome), BPD, death, hearing loss, serum electrolyte AEs, and nephrocalcinosis were estimated using logistic regression adjusted for gestational age.</div></div><div><h3>Results</h3><div>We found 293 AEs in 74 of 80 (93%) infants, including 223 AEs among 56 of 61 (92%) infants who received furosemide and 70 AEs among 18 of 19 (95%) infants who received placebo (<em>P</em> &gt; .99). Adjusted analysis among all groups showed no difference in the odds of having moderate-to-severe BPD or death at 36 weeks post-menstrual age (<em>P</em> = .32), hearing loss (<em>P</em> = .78), or nephrocalcinosis (<em>P</em> = .39). For serum electrolyte AE, OR (furosemide vs placebo) was 4.46 (95% CI, 1.06-21.70; <em>P</em> = .048) for cohort 1 and 7.89 (95% CI, 1.50-61.91; <em>P</em> = .023) for cohort 2.</div></div><div><h3>Conclusions</h3><div>In preterm infants, furosemide did not increase the overall incidence of AEs, hearing loss, or nephrocalcinosis, but did increase the incidence of electrolyte abnormalities. Furosemide given for 28 consecutive days was not associated with a difference in moderate-to-severe BPD or death at 36 weeks postmenstrual age.</div></div><div><h3>Clinicaltrials.gov</h3><div><span><span>NCT02527798</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"283 ","pages":"Article 114629"},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058640","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":"Ten-Year Trends in Pharmacologic Management of Gastroesophageal Reflux Disease and Pediatric Feeding Disorders in Young Children","authors":"Suzanna Hirsch MD ,&nbsp;Enju Liu MD, PhD ,&nbsp;Samuel Nurko MD, MPH ,&nbsp;Rachel Rosen MD, MPH","doi":"10.1016/j.jpeds.2025.114628","DOIUrl":"10.1016/j.jpeds.2025.114628","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate 10-year trends in pharmacologic management of young children with gastroesophageal reflux disease (GERD) or pediatric feeding disorder (PFD), a population at risk for over prescribing.</div></div><div><h3>Study design</h3><div>Single-center, retrospective cohort study of children ≤2 years diagnosed with GERD or PFD between January 2014 and December 2023. Prescriptions were searched for proton pump inhibitors (PPI), H2-receptor antagonists (H2RA), cyproheptadine, erythromycin, metoclopramide, or prucalopride, and procedures were searched for intrapyloric botulinum injections. The change over time in the percent of patients with GERD or PFD prescribed each medication class was assessed using the Cochran-Armatage test for trend.</div></div><div><h3>Results</h3><div>There were 49 483 children ≤2 years diagnosed with GERD or PFD across all years, with an increasing number of patients seen annually (6516 in 2014 vs 9109 in 2023). The percent of patients receiving any prescription for GERD or PFD declined by almost 50%, from 36.5% in 2014 to 18.7% in 2023 (<em>P</em> &lt; .001). There was a particular decline in PPI prescriptions, with 25.3% of patients receiving PPI in 2014 and 7.1% receiving PPI in 2023 (<em>P</em> &lt; .001), and also a decline in H2RA prescriptions, with 17.0% of patients receiving H2RA in 2014 and 11.1% receiving H2RA in 2023 (<em>P</em> &lt; .0001). Decreases over time also were seen in the percent of patients prescribed erythromycin (<em>P</em> = .045) and metoclopramide (<em>P</em> = .006), while there was an increase in the percent of patients prescribed cyproheptadine (<em>P</em> = .009) and prucalopride (<em>P</em> &lt; .0001). Intrapyloric botulinum injections increased but remained infrequent.</div></div><div><h3>Conclusions</h3><div>In this large, single-center study, prescriptions for young children with GERD or PFD declined over this 10-year period. There were substantial declines in PPI prescribing, contrasting with prior studies. These trends may indicate growing alignment of practice with consensus recommendations that advise against acid suppression as first-line management in this population.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"283 ","pages":"Article 114628"},"PeriodicalIF":3.9,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032895","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":"Influenza Vaccination in the Pediatric Emergency Department: The Importance of Integrated Health Records","authors":"Anne Ewing MD,&nbsp;Adam J. Ratner MD, MPH","doi":"10.1016/j.jpeds.2025.114627","DOIUrl":"10.1016/j.jpeds.2025.114627","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"283 ","pages":"Article 114627"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995706","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}