Journal of Pediatrics最新文献

{"title":"Changes in Access to High Pediatric Readiness Emergency Care in the United States from 2013 to 2021.","authors":"Allan M Joseph, Kristin N Ray, Kristen S Kurland, Hilary A Hewes, Kathleen M Brown, Billie S Davis, Jeremy M Kahn","doi":"10.1016/j.jpeds.2025.114834","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114834","url":null,"abstract":"<p><strong>Objective: </strong>To assess changes in access to high readiness emergency departments (ED) between the 2013 and 2021 editions of the National Pediatric Readiness Project (NPRP) assessments.</p><p><strong>Study design: </strong>We performed a geospatial analysis of ED responses to the NPRP assessments, linked to national census data. We defined high pediatric readiness EDs as those scoring above the 75th percentile in the 2013 assessment. We defined timely access as living within a 30-minute drive of such an ED. We calculated the proportion of children with timely access nationally, by state, and by hospital referral region, and also assessed changes over time. Given potential impacts of the COVID-19 pandemic on staffing, we conducted a secondary analysis excluding staffing-related domains of readiness.</p><p><strong>Results: </strong>Between 2013 and 2021, the proportion of children with timely access to a high readiness ED decreased from 70.2% to 66.7%, representing 2.1 million fewer children. However, many states and regions experienced improvements in access exceeding 10 percentage points. When excluding domains of readiness related to staffing, access to EDs with high equipment- and process-related readiness increased from 75.8% to 79.5%.</p><p><strong>Conclusions: </strong>Pediatric access to high readiness EDs modestly declined over time, but some areas saw meaningful improvements. Excluding staffing-related readiness, which may have been affected by the COVID-19 pandemic, an increase in access was observed. Future work should examine regions with improved access to identify strategies for further improving pediatric emergency care.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114834"},"PeriodicalIF":3.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187805","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":"Sustained Increase in Pediatric Mastoiditis in the Post-COVID-19 Era in France: A 9-Year Interrupted Time-Series Analysis.","authors":"Apolline Furgier, Romain Basmaci, Zaba Valtuille, Inès Fafi, Zein Assad, Lea Lenglart, Natacha Teissier, Charlotte Benoit, Emilien Chebib, Aurélie Bourmaud, François Angoulvant, Pierre Alex Crisinel, André Birgy, Naïm Ouldali, Manon Jaboyedoff","doi":"10.1016/j.jpeds.2025.114835","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114835","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of COVID-19 pandemic-related, non-pharmaceutical interventions (NPI) on the incidence of mastoiditis cases, causative pathogens, and associated complications in children.</p><p><strong>Study design: </strong>We conducted a population-based, interrupted time-series analysis using national surveillance data from France between January 2016 and December 2024. All hospitalized mastoiditis cases among individuals younger than 18 years in France were included. The main outcome was the monthly incidence of mastoiditis cases, analyzed using quasi-Poisson regression models, accounting for seasonality.</p><p><strong>Results: </strong>We included 7390 hospitalized cases of mastoiditis in children. Following a decrease in the incidence of mastoiditis by 58.9 % (95% CI: 68.2% to 46.9%, p <0.001) during the strict NPI period, we observed an increase of 71.7% (95% CI: 26.4% to 133.3%, p <0.001) in the post-NPI period compared with the expected trend without NPI. The proportions of complicated cases and those requiring surgery remained stable over time. By pathogen, the most important increase in the post-NPI period was observed among mastoiditis caused by Streptococcus pyogenes (627.8%, 95% CI: 269.1% to 1335.0%, p <0.001), followed by Streptococcus pneumoniae (135.6%, 95% CI: 20.5% to 360.6%, p = 0.012) and Haemophilus influenzae (+124.3%, -17.0% to 506.0%, p = 0.111).</p><p><strong>Conclusions: </strong>In this 9-year, population-based national study, we observed a sustained increase in the incidence and etiology of mastoiditis in children during the post-COVID-19 period. We hypothesize that these changes, associated with NPI during the pandemic and lifting post-pandemic, reflect consequences that should be considered in management of future pandemics.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114835"},"PeriodicalIF":3.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187252","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":"From Hospital to Home: Continuity between Skin-to-Skin Care and Later Verbal Engagement in Infants Born Preterm.","authors":"Pamela M Rios, Virginia A Marchman, Molly F Lazarus, Nuria L Ontiveros Perez, Melissa Scala, Katherine E Travis, Heidi M Feldman","doi":"10.1016/j.jpeds.2025.114837","DOIUrl":"10.1016/j.jpeds.2025.114837","url":null,"abstract":"<p><p>This descriptive cohort study documented continuity between family-delivered skin-to-skin care rates for preterm infants in the NICU and amounts of child-directed speech at child age 9 months. Involvement in skin-to-skin care may be an early marker of caregiver-infant engagement and a target for early interventions that support positive caregiver-infant interactions.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114837"},"PeriodicalIF":3.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187757","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":"Maternal COVID-19 Test Positivity and Outcomes of Extremely Preterm Infants in the Neonatal Intensive Care Unit.","authors":"Emily A Messick, Shampa Saha, Jonathan L Slaughter, Matthew J Kielt, Kristen L Benninger, Edward F Bell, Barbara J Stoll, Karen M Puopolo, Sagori Mukhopadhyay, Dustin D Flannery, Myra H Wyckoff, C Michael Cotten, Ravi M Patel, Abbot R Laptook, Cathy Grisby, Abhik Das, Michele C Walsh, Pablo J Sánchez","doi":"10.1016/j.jpeds.2025.114840","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114840","url":null,"abstract":"<p><strong>Objective: </strong>To describe the neonatal intensive care unit outcomes of infants born extremely preterm to mothers who test positive for SARS-CoV-2 during pregnancy.</p><p><strong>Study design: </strong>Prospective study (3/1/2020-4/30/2023) at 16 NICHD Neonatal Research Network centers of inborn infants (birth weight 401-1000 grams and/or gestational age <29 weeks) born to mothers tested for SARS-CoV-2 during pregnancy. Frequency of maternal SARS-CoV-2 detection, vertical transmission rate, and association of maternal SARS-CoV-2 positivity during pregnancy with infant outcomes were determined.</p><p><strong>Results: </strong>During the 38-month study, 4548 extremely preterm infants were born to 4072 mothers tested for SARS-CoV-2 during pregnancy. Overall, 7% (297/4072) of mothers had a positive SARS-CoV-2 test; 1% (2/181) of tested infants were positive at age <72 hours. The majority of outcomes (eg, bronchopulmonary dysplasia, retinopathy of prematurity) did not differ between infants of test-positive vs test-negative mothers. Infants of test-positive mothers were more likely to be diagnosed with necrotizing enterocolitis (NEC) than those of test-negative mothers (14% vs 11%; p=0.03). In adjusted analyses, infants born to test-positive mothers were more likely to develop NEC (risk ratio 1.40; 95% CI 1.03 -1.89; p=0.03) or the combined outcome of death within 12 hours of age or NEC (risk ratio 1.33; 95% CI, 1.09-1.62; p<0.01) but not death within 12 hours of age (risk ratio 1.22, 95% CI 0.92-1.62; p=0.16) or before discharge (risk ratio 0.83, 95% CI 0.55-1.26; p=0.38).</p><p><strong>Conclusions: </strong>Among infants <29 weeks' gestation, vertical transmission of SARS-CoV-2 was infrequent. Maternal SARS-CoV-2 positivity was associated with NEC but not with other infant outcomes or mortality.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114840"},"PeriodicalIF":3.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186444","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":"Antibiotic Prophylaxis for Gastrointestinal Surgery Among Neonates and Very Young Infants: National Patterns, Outcomes, and Opportunities for Precision Stewardship.","authors":"Humza Thobani, Roshni Mathew, Anam N Ehsan, Anoosha Moturu, Muhammad O Khan, Laura Bio, Meera Sankar, Timothy F Tirrell, Adil A Shah, Chad M Thorson, Steven L Raymond, Saleem Islam, Karl G Sylvester, Faraz A Khan","doi":"10.1016/j.jpeds.2025.114839","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114839","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate nationwide adherence to surgical antibiotic prophylaxis (SAP) guidelines and the association with outcomes following gastrointestinal surgeries among neonates and infants.</p><p><strong>Study design: </strong>We queried the National Surgical Quality Improvement Program-Pediatric for all patients age <90 days undergoing gastrointestinal surgery between 2021-2023. Procedures were further subcategorized by anatomic site. SAP regimens were classified as being \"adherent,\" \"undercoverage,\" or \"overcoverage\" per established guidelines and expert consensus. The primary outcome was surgical site infection (SSI). Associations between SAP classification and SSI rates for each procedure subcategory were analyzed, with further subset analyses to delineate the effects of common SAP regimens on postoperative outcomes.</p><p><strong>Results: </strong>A total of 11,062 cases met criteria, with an overall SAP adherence of 87.2%. Rates of overcoverage (2.8%-55.5%) and undercoverage (2.8%-28.3%) varied widely by procedure type. SAP undercoverage did not increase the odds of SSI for most procedures analyzed, with the exception of patients undergoing colorectal procedures, in whom cefazolin monotherapy (undercoverage) was associated with higher odds of SSI (OR=2.17, 95% CI=1.08-4.18). Broadening SAP coverage (overcoverage) and prolonging SAP duration were not associated with reduced SSI rates for any subcategory of procedure.</p><p><strong>Conclusion: </strong>Adherence to empiric SAP guidelines has been applied poorly to neonates and very young infants undergoing gastrointestinal surgery. There appears to be limited benefit to broadening SAP coverage for surgery in this patient population. These findings underscore the need for increased adherence to recommendations driven by neonatal-specific data , aiming to balance optimized post-operative outcomes with antimicrobial stewardship goals.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114839"},"PeriodicalIF":3.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187736","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":"Infant Renal Replacement Therapy Using Carpediem™: A Multicenter Observational Cohort Study from the ICONIIC Learning Network.","authors":"Cara L Slagle, Kim T Vuong, Kelli A Krallman, Lauren Casey, Katja M Gist, Jennifer G Jetton, Catherine Joseph, Kera Luckritz, Susan D Martin, Jolyn Morgan, Kyle A Merrill, Katie Plomaritas, David Ramirez, Cheryl L Tran, H Stella Shin, Amanda N Snyder, Brynna Van Wyk, Larissa Yalon, Stuart L Goldstein, Shina Menon","doi":"10.1016/j.jpeds.2025.114838","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114838","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate indications and outcomes of Carpediem™ as the first infant-specific continuous renal replacement therapy (CRRT) platform available for clinical use in the US.</p><p><strong>Study design: </strong>A multicenter, retrospective and prospective observational study was conducted through the \"Improving CRRT Outcomes in Neonates and Infants through Interdisciplinary Collaboration (ICONIIC)\" Learning Network. Data were collected from the first four US centers utilizing Carpediem™. A treatment course was defined as sequential CRRT procedures separated by ≤72 hours. Infant cohorts were categorized by CRRT indication: end-stage kidney disease (ESKD) (ie, CRRT as a bridge to PD) and non-ESKD (all other indications).</p><p><strong>Results: </strong>Sixty-seven infants underwent 93 treatment courses using 1,538 filters and 112 vascular access catheters. Primary indication for CRRT was ESKD in 36 (54%) and acute kidney injury in 43%. Median age at first treatment was 18 (IQR: 6, 81) days, and dry weight 2.6 (IQR: 2.4, 3.1) kg for the ESKD cohort and 32 (IQR: 9, 90) days and 3.4 (IQR: 3.2, 4.5])kg for the non-ESKD cohort. Median treatment course duration was 12 (IQR: 3,24) days for ESKD compared with 4 [IQR: 1,13] days for non-ESKD infants. Survival to hospital discharge was 67% in ESKD and 60% in non-ESKD.</p><p><strong>Conclusion: </strong>In this US cohort study, CRRT survival in infants treated with Carpediem™ exceeds 60%. More than half of the treatment indications were for ESKD as a bridge to dialysis.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114838"},"PeriodicalIF":3.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187818","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":"Lung Hypoperfusion in Children with Congenital Diaphragmatic Hernia Could be Assessed by Doppler Echocardiography.","authors":"Luis Moral","doi":"10.1016/j.jpeds.2025.114829","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114829","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114829"},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182336","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":"Rebecca A Stark","doi":"10.1016/j.jpeds.2025.114831","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114831","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114831"},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182357","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":"Extending the Evidence on Immune Debt: Country-Specific NPI Profiles, Age Stratification, and Pathogen Attribution.","authors":"Yahong Wang, Yali Yang","doi":"10.1016/j.jpeds.2025.114833","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114833","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114833"},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182401","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":"Léa Lenglart, Luigi Titomanlio, Ruud G Nijman, Naim Ouldali","doi":"10.1016/j.jpeds.2025.114832","DOIUrl":"https://doi.org/10.1016/j.jpeds.2025.114832","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114832"},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182352","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}