Journal of Pediatrics最新文献

{"title":"Neurodevelopmental Follow-Up in Children with Intrauterine and Perinatal Exposure to Chikungunya Virus","authors":"Fátima Cristiane Pinho de Almeida Di Maio Ferreira MD, PhD ,&nbsp;Karin Nielsen-Saines MD, MPH ,&nbsp;Maria Elisabeth Lopes Moreira MD, PhD ,&nbsp;Aline Dessimoni Salgado MD ,&nbsp;Roozemeria Pereira Costa MS ,&nbsp;Simone B. de Campos PhD ,&nbsp;Dajie Zhang PhD ,&nbsp;Britta Hüning MD ,&nbsp;Christa Einspieler PhD ,&nbsp;Peter B. Marschik Dphil, DMsc, PhD ,&nbsp;Trevon Fuller PhD ,&nbsp;Patricia Brasil MD, PhD","doi":"10.1016/j.jpeds.2025.114477","DOIUrl":"10.1016/j.jpeds.2025.114477","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effects of intrauterine and perinatal exposure to chikungunya virus (CHIKV) on neurodevelopment in infants and toddlers.</div></div><div><h3>Study design</h3><div>We conducted a cohort study comparing children with intrauterine or perinatal exposure to maternal CHIKV infection with unexposed controls in Rio de Janeiro, Brazil. Neurodevelopment was assessed with General Movement Assessments in the first 6 months of life, and the Bayley-III Scales of Infant and Toddler Development and Modified Checklist for Autism in Toddlers for older children. Developmental delay (DD) was defined as a Bayley score less than 70 and risk of DD as a score less than 85.</div></div><div><h3>Results</h3><div>Among 60 children exposed to intrauterine or perinatal CHIKV, 20 (33%) had laboratory confirmation of CHIKV infection by reverse transcription polymerase chain reaction or immunoglobulin M serology and 40 did not; 44 exposed children (15 infected and 29 uninfected) had General Movement Assessment performed, with 19% having suboptimal or abnormal results. At 11-42 months of age, 35 exposed children and 78 unexposed controls had Bayley-III assessments. Compared with controls, exposed children had higher rates of DD (7 [20%] vs 2 [3%], <em>P</em> = .004) driven by the language domain, and greater risk of DD driven by motor and cognitive domains scores (10 [29%] vs 10 [13%], <em>P</em> = .03 and 8 [23%] vs 5 [6%], <em>P</em> = .02, respectively). Eight of 35 (23%), CHIKV exposed children screened positive for autism spectrum disorder. CHIKV-exposed uninfected children had 2 (9.5%) cases of DD and 5 (23.8%) cases of autism spectrum disorder.</div></div><div><h3>Conclusions</h3><div>Abnormal neurodevelopmental results were seen in both infected and uninfected children with intrauterine or perinatal CHIKV exposure. Infant neurodevelopment monitoring should be considered following exposure to maternal CHIKV infection in pregnancy to facilitate early interventions and to mitigate neurodevelopmental sequelae.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114477"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048821","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":"Balancing Volume and Outcomes: Insights and Cautions from a Multistate Analysis of Care for Infants Born Very Preterm","authors":"Siyuan Jiang MD, PhD,&nbsp;Henry C. Lee MD","doi":"10.1016/j.jpeds.2025.114481","DOIUrl":"10.1016/j.jpeds.2025.114481","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"280 ","pages":"Article 114481"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048681","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":"Cyclosporine Treatment in Patients with Kawasaki Disease and Coronary Artery Aneurysms or Treatment Resistance","authors":"Irene Bellicini MD ,&nbsp;Emelia Bainto BA ,&nbsp;Chisato Shimizu MD ,&nbsp;Jane C. Burns MD ,&nbsp;Adriana H. Tremoulet MD, MAS","doi":"10.1016/j.jpeds.2025.114479","DOIUrl":"10.1016/j.jpeds.2025.114479","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the clinical course and outcome of 33 patients with Kawasaki disease (KD) treated with cyclosporine (CSA) for coronary artery abnormalities (CAA) or treatment resistance.</div></div><div><h3>Study design</h3><div>Single-center, retrospective study of patients with KD treated from 2013 through 2023 for CAA or treatment resistance. Demographics, laboratory studies, medications, adverse events, and echocardiographic data were analyzed.</div></div><div><h3>Results</h3><div>Of the 33 KD patients treated with CSA, 25 patients received CSA for CAA and 8 for treatment resistance. Four patients received CSA intravenously initially, followed by oral therapy. Since 2014, all patients received CSA orally only. The target 2-hour postdose level (300-600 ng/ml) was best achieved by dividing 5 mg/kg/day every 12 hours. We developed a standardized treatment protocol based on our experiences with this patient population. The patients treated for CAA all showed improved coronary artery Z-scores at both the 2-week and 6-week follow-up. Two patients experienced significant adverse events. One patient had posterior reversible encephalopathy syndrome, while the other developed Epstein-Barr virus-associated lymphoproliferative disorder. Discontinuation of CSA led to complete recovery in both cases.</div></div><div><h3>Conclusions</h3><div>CSA was generally well tolerated in patients with KD and CAA or treatment resistance. Our study contributes to the limited literature on CSA use in KD, providing dosing guidance and advocating for cautious monitoring.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114479"},"PeriodicalIF":3.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043392","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":"The Full Range of Weight Status by Race and Ethnicity in Children with and without Autism in the United States: A Cross-Sectional Study","authors":"Aviva Must PhD ,&nbsp;Misha Eliasziw PhD ,&nbsp;Linda G. Bandini PhD, RD ,&nbsp;Carol Curtin PhD, MSW ,&nbsp;Sandy Magaña PhD, MSW ,&nbsp;Katherine M. Rancaño PhD","doi":"10.1016/j.jpeds.2025.114482","DOIUrl":"10.1016/j.jpeds.2025.114482","url":null,"abstract":"<div><h3>Objective</h3><div>To identify and characterize how race and ethnicity influence the relationship between autism and weight status, across all categories of weight from underweight to severe obesity.</div></div><div><h3>Study design</h3><div>We developed a propensity score-matched cross-sectional dataset of children with and without parent-reported autism in the National Survey of Children Health (2016-2022) and Adolescent Brain and Cognition Development Study (2016-2018). We included non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, and Hispanic children aged 6-17 years. Prevalence ratios for autistic and nonautistic children were estimated with multinomial regression models across Centers for Disease Control-defined categories for underweight, healthy weight, overweight, mild-to-moderate obesity, and severe obesity, based on parent-reported height and weight and measured heights and weights (Adolescent Brain and Cognition Development Study).</div></div><div><h3>Results</h3><div>Prevalence disparities across racial and ethnic groups were evident and the pattern of prevalence ratios (autistic: nonautistic) showed remarkably consistent U- or J-shaped prevalence ratios. Prevalence ratios were elevated in underweight and severe obesity for autistic Asian, Black, White, and Hispanic children compared with their nonautistic peers of the same race or ethnicity, with the exception of underweight prevalence where autistic and nonautistic Asian children did not differ.</div></div><div><h3>Conclusions</h3><div>The largely consistent pattern of prevalence ratios comparing autistic and nonautistic children for underweight and severe overweight in the 4 major racial and ethnic groups in the US suggests that health care and other providers should be aware of these risks in autistic children, actively monitor their weight status, and intervene early to prevent excess weight loss or weight gain.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"280 ","pages":"Article 114482"},"PeriodicalIF":3.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048824","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 Relationship Between Hispanic Ethnicity and Outcomes for Infants Born Extremely Preterm","authors":"Jane E. Brumbaugh MD ,&nbsp;Carla M. Bann PhD ,&nbsp;Edward F. Bell MD ,&nbsp;Colm P. Travers MD ,&nbsp;Betty R. Vohr MD ,&nbsp;Elisabeth C. McGowan MD ,&nbsp;Heidi M. Harmon MD, MS ,&nbsp;Waldemar A. Carlo MD ,&nbsp;Susan R. Hintz MD, MS Epi ,&nbsp;Andrea F. Duncan MD, MS","doi":"10.1016/j.jpeds.2025.114474","DOIUrl":"10.1016/j.jpeds.2025.114474","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the association between maternal ethnicity and infant survival to discharge without major morbidity.</div></div><div><h3>Study design</h3><div>This is secondary analysis of a prospective cohort of infants born &lt;27 weeks of gestation at National Institute of Child Health and Human Development Neonatal Research Network centers from 2006 through 2020. The primary outcome was survival to discharge without major morbidity (sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia grade 3, intracranial hemorrhage grade ≥3, periventricular leukomalacia, and advanced retinopathy of prematurity). Outcomes were compared by ethnicity and adjusted for center, perinatal characteristics, and sociodemographic characteristics.</div></div><div><h3>Results</h3><div>Of 14 029 subjects, 2155 (15%) were Hispanic, 6116 (44%) non-Hispanic Black, and 5758 (41%) non-Hispanic White. Infants of Hispanic mothers had the lowest survival to discharge without major morbidity (Hispanic 523/2099 [25%], non-Hispanic Black 1701/5940 [29%], non-Hispanic White 1494/5597 [27%], <em>P</em> = .002). Adjusted odds of survival without major morbidity differed between Hispanic and non-Hispanic Black (adjusted odds ratio [aOR] 0.80, 95% CI 0.69-0.93), but not between Hispanic and non-Hispanic White infants (aOR 1.07, 95% CI 0.92-1.25). At 2 years, children of non-Hispanic White mothers had the lowest incidence of neurodevelopmental impairment (Hispanic 544/1235 [44%], non-Hispanic Black 1574/3482 [45%], and non-Hispanic White 1004/3182 [32%], <em>P</em> &lt; .001). Odds of impairment were greater for Hispanic than non-Hispanic White children (aOR 1.25, 95% CI 1.05-1.48) but did not differ between Hispanic and non-Hispanic Black children (aOR 0.88, 95% CI 0.74-1.04).</div></div><div><h3>Conclusions</h3><div>In a multicenter cohort, infants of Hispanic mothers had lower odds of survival to discharge without major morbidity than infants of non-Hispanic Black mothers and similar odds of survival without major morbidity as infants of non-Hispanic White mothers.</div></div><div><h3>ClinicalTrials.gov ID</h3><div>Generic Database: <span><span>NCT00063063</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114474"},"PeriodicalIF":3.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043408","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":"Data Collection Variability Across Neonatal Hypoxic-Ischemic Encephalopathy Registries","authors":"Eric S. Peeples MD, PhD ,&nbsp;Ulrike Mietzsch MD ,&nbsp;Eleanor Molloy MBBCh, PhD ,&nbsp;Gabrielle deVeber MD ,&nbsp;Khorshid Mohammad MD ,&nbsp;Janet S. Soul MD ,&nbsp;Danielle Guez-Barber MD, PhD ,&nbsp;Betsy Pilon ,&nbsp;Vann Chau MD ,&nbsp;Sonia Bonifacio MD ,&nbsp;Jehier Afifi MBBCh, MSc ,&nbsp;Alexa Craig MD ,&nbsp;Pia Wintermark MD","doi":"10.1016/j.jpeds.2025.114476","DOIUrl":"10.1016/j.jpeds.2025.114476","url":null,"abstract":"<div><h3>Objective</h3><div>To assess variability among data elements collected among existing neonatal hypoxic-ischemic encephalopathy (HIE) data registries worldwide and to determine the need for future harmonization of standard common data elements.</div></div><div><h3>Study design</h3><div>This was a cross-sectional study of data elements collected from current or recently employed HIE registry data forms. Registries were identified by literature search and email inquiries to investigators worldwide. Data elements were categorized by group consensus.</div></div><div><h3>Results</h3><div>A total of 1281 data elements were abstracted from 22 registries based in 14 countries, including 3 middle-income countries. Registries had a median of 106.5 distinct data elements per registry (range 59-458). The most commonly collected data were related to pregnancy, therapeutic hypothermia, and short-term hospital outcomes. The least consistently collected data were laboratory values other than acid/base status values. Only 4 variables were consistently collected in every registry. Five registries included neurodevelopmental follow-up fields and 5 others linked their data to a separate follow-up registry.</div></div><div><h3>Conclusion</h3><div>Many HIE registries are collecting patient data around the world, but there is considerable variability in the number, type, and format of data collected. Future attempts to develop standard common data elements to harmonize data collection globally will be crucial to facilitate worldwide collaboration and to optimize management and outcome of neonatal HIE.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114476"},"PeriodicalIF":3.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043404","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":"Physiologic Pulmonary Phenotyping of Infants Born Preterm and Post-Discharge Respiratory Morbidity","authors":"Robert S. Tepper MD, PhD ,&nbsp;Brandie D. Wagner PhD ,&nbsp;Jeffrey Bjerregaard RRT ,&nbsp;Christina Tiller RRT ,&nbsp;Laura Amos RN ,&nbsp;Greg Sokol MD ,&nbsp;Dominic Adducci BS ,&nbsp;Steven H. Abman MD","doi":"10.1016/j.jpeds.2025.114475","DOIUrl":"10.1016/j.jpeds.2025.114475","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether airway and parenchymal function identifies subgroups of infants born preterm according to the predominant pulmonary pathophysiology, and whether these subgroups have different risks for respiratory disease during infancy.</div></div><div><h3>Study design</h3><div>We prospectively enrolled a cohort of 125 infants born preterm with planned clinical follow-up after neonatal intensive care unit discharge. The study included monthly questionnaires for wheeze and visits to a physician or care provider for any respiratory illness. In addition, infant lung function testing near 5 months corrected-age included measures of airways and parenchymal function using forced expiratory flows, alveolar volume (V_A), and the carbon monoxide transfer constant (diffusion capacity of lung [D_L]/V_A). Phenotypes were defined using 2 approaches: an a priori defined phenotypes based on forced expiratory flow 75% and D_L/V_A z-scores, and an unbiased approach to classifying infants using k-means clustering.</div></div><div><h3>Results</h3><div>We identified 4 pulmonary physiologic phenotypes that distinguished participants with predominantly decreased airway and/or parenchymal function. Although the worst physiologic phenotypes were associated with a lower gestational age at birth, these phenotypes had a better predictive value than gestational age, sex, and diagnosis of bronchopulmonary dysplasia for increased respiratory morbidity during infancy (area under the curve = 0.71 vs 0.63 for respiratory illness and 0.69 vs 0.63 for wheeze).</div></div><div><h3>Conclusions</h3><div>Physiologic pulmonary phenotypes of infants born preterm were associated with differential risks for respiratory morbidities as infants, which may identify heterogeneous risks for long-term respiratory sequelae to individualize therapeutic strategies.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114475"},"PeriodicalIF":3.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043406","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":"Rural School-Based Health Centers: Meeting Children Where They Are to Improve Asthma Outcomes.","authors":"James Bohnhoff, Abby Fleisch, Jill S Halterman","doi":"10.1016/j.jpeds.2025.114473","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114473","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114473"},"PeriodicalIF":3.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024794","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":"Neurodevelopmental Outcomes after Fetoscopic Myelomeningocele Repair","authors":"Romain Corroenne MD, PhD ,&nbsp;Sabrina Rangwani BS ,&nbsp;William E. Whitehead MD ,&nbsp;Rebecca M. Johnson MS, CCRP ,&nbsp;Ahmed A. Nassr MD ,&nbsp;Cara Buskmiller MD ,&nbsp;Jessian L. Munoz MD, PhD ,&nbsp;Jonathan Castillo MD, MPH ,&nbsp;Heidi Castillo MD ,&nbsp;Roopali V. Donepudi MD ,&nbsp;Michael A. Belfort MD, PhD ,&nbsp;Magdalena Sanz Cortes MD, PhD","doi":"10.1016/j.jpeds.2025.114472","DOIUrl":"10.1016/j.jpeds.2025.114472","url":null,"abstract":"<div><h3>Objectives</h3><div>To report the neurodevelopmental outcomes after a fetoscopic myelomeningocele repair and to compare them with children who had an open hysterotomy repair or a postnatal repair.</div></div><div><h3>Study design</h3><div>We included 132 infants (prenatal repair, 93 [69 fetoscopic and 24 open hysterotomy]; postnatal repair, 39). Neurodevelopmental outcomes at or beyond 18 months were evaluated by a developmental pediatrician using the Capute scales (Clinical Adaptive Test [CAT]/Clinical Linguistic &amp; Auditory Milestone Scale [CLAMS]) and/or during parental interview using Developmental Profile 3 test. Scores were examined against reference values at each gestational age. A normal score was defined as ≥70%. Neurodevelopmental scores were compared while adjusting for infants’ age at the time of testing and the need for hydrocephalus treatment.</div></div><div><h3>Results</h3><div>After a fetoscopic repair, normal CLAMS results were observed in 25 of 33 cases (75.8%) and normal CAT in 23 of 33 (69.7%); the Developmental Profile 3 showed normal social-emotional scores in 60 of 65 (92.3%), normal cognition in 55 of 65 (84.6%), normal communication in 51 of 65 (78.5%), normal adaptive behavior in 48 of 65 (73.8%), normal general development in 39 of 65(60%), and normal physical score in 31 of 65 (47.7%) of the cases. Children who underwent a fetoscopic repair had similar neurodevelopmental outcomes compared with those who had an open fetal surgery repair. There was a significantly higher proportion of children with a normal CLAMS (25/33 [75.8%] vs 12/39 [30.8%], <em>P</em> &lt; .01) and normal CAT (23/33 [69.7%] vs 16/39 [41.0%], <em>P</em> = .04) in the fetoscopic group compared with the postnatal repair group.</div></div><div><h3>Conclusions</h3><div>Children who undergo laparotomy-assisted fetoscopic myelomeningocele repair present with normal neurodevelopmental outcomes in two-thirds of the cases included in this study at ≥ 18 months of age and had similar neurodevelopmental outcomes as those who had an open fetal surgery repair.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114472"},"PeriodicalIF":3.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016927","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":"Pediatric Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder: Analyzing National Treatment Trends","authors":"Raman Baweja MD, MS ,&nbsp;Daniel A. Waschbusch PhD ,&nbsp;Lan Kong MS, PhD ,&nbsp;Banku Jairath MD ,&nbsp;Ritika Baweja MD ,&nbsp;Usman Hameed MD ,&nbsp;James G. Waxmonsky MD","doi":"10.1016/j.jpeds.2025.114471","DOIUrl":"10.1016/j.jpeds.2025.114471","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigated how a disruptive mood dysregulation disorder (DMDD) diagnosis influences treatment selection and sequencing in children with attention-deficit/hyperactivity disorder (ADHD).</div></div><div><h3>Study design</h3><div>This multicenter, population-based, retrospective cohort study analyzed data from TriNetX Research Network (June 2013 through July 2024). Youth with ADHD (without DMDD) formed the control cohort (n = 631 295). Youth with ADHD + DMDD (n = 24 723) formed the study cohort. Odds ratios (ORs) and relative risks were calculated to analyze associations.</div></div><div><h3>Results</h3><div>Compared with controls, ADHD + DMDD cohort was more likely to be composed of non-Hispanic ethnicity and exhibited higher rates of psychiatric comorbidities, inpatient and emergency service utilization, and billed psychotherapy (ORs range 1.25-6.95). Youth with ADHD + DMDD were more likely to receive ADHD medications (ORs range 1.55-4.80), as well as antidepressants, mood stabilizers, and antipsychotics (ORs range 5.05-13.16). Hispanic youth with DMDD utilized more psychotropics but less psychotherapy, while White youth used all services more. Before the use of non-ADHD medications for aggression, only 25% of ADHD + DMDD youth had a therapy code, and around 11% showed evidence of optimization of ADHD medication. After a DMDD diagnosis, treatment rates for other psychotropics increased more than those for central nervous system stimulants.</div></div><div><h3>Conclusions</h3><div>In youth with ADHD, a DMDD diagnosis is associated with increases in the spectrum of pharmacological and nonpharmacological treatments deployed with patterns varying by race and ethnicity. Antipsychotic and mood stabilizer prescriptions increased most prominently, often before receiving psychotherapy services or efforts to optimize ADHD medication. Future research should address disparities in DMDD treatment patterns and identify the optimal treatment sequences for DMDD.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114471"},"PeriodicalIF":3.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015716","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}