Journal of Pediatrics最新文献

{"title":"Nationwide Evidence on Rotavirus Vaccination and Celiac Disease: Strengths and Remaining Gaps.","authors":"Fernanda Cristofori, Stefania Castellaneta, Vanessa Nadia Dargenio, Ruggiero Francavilla","doi":"10.1016/j.jpeds.2026.115134","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115134","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115134"},"PeriodicalIF":3.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823646","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":"Between Machines and Mortality.","authors":"Idan Yoel","doi":"10.1016/j.jpeds.2026.115132","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115132","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115132"},"PeriodicalIF":3.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823662","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 Effect of Preterm Birth on Physical Activity for 9-12-Year-Old Children.","authors":"Kate L Cameron, Cassidy Du Berry, Maria Angel, Joy E Olsen, Melissa Middleton, Ross A Clark, Liam Welsh, Jeanie L Y Cheong, Alicia J Spittle, Tara L FitzGerald","doi":"10.1016/j.jpeds.2026.115115","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115115","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effect of preterm birth on physical activity (PA) in 9-12-year-old children, and to describe group differences in relationships between PA and lung function, and PA and respiratory morbidity, between children born preterm and term.</p><p><strong>Study design: </strong>343 children completed follow-up including children born very preterm (VPT; <30 weeks of gestation, n=91), moderate-late preterm (MLPT; 32-36 weeks of gestation, n=139) and term (n=117). PA was measured using 7-day accelerometry and the Physical Activity Questionnaire for Older Children (PAQ-C). Imputation models were used to handle missing data as the total sample recruited at birth included 551 participants.</p><p><strong>Results: </strong>Children born VPT had more stationary (mean difference (MD): 32 minutes, 95% CI 4, 60; p=0.024) and screen time (MD: 25 minutes, 95% CI 0.2, 50; p=0.048), and had lower PAQ-C scores (MD: -0.3, 95% CI -0.4, -0.1; p=0.001) than term-born children. Children born MLPT completed more screen time (MD: 22 minutes, 95% CI 1, 43; p=0.038) than term-born children. All children failed to meet moderate-vigorous PA recommendations (≥60 minutes/day), with 16.6 minutes on average observed across all participants.</p><p><strong>Conclusions: </strong>Children born VPT were more sedentary with lower PAQ-C scores, and both preterm groups (VPT and MLP) had higher screen time than children born at term. No children met moderate-vigorous PA guidelines, indicating early, targeted strategies to curb sedentary behavior and promote activity should be prioritized.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115115"},"PeriodicalIF":3.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789576","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":"Examining Racial and Ethnic Differences in Referral and Management of Central Precocious Puberty in a Pediatric Endocrinology Clinic.","authors":"Chineze Ebo, Gajanthan Muthuvel, Jordyn McCray, Stephanie Penix, Lindsey Hornung, Nana-Hawa Yayah Jones, Iris Gutmark-Little","doi":"10.1016/j.jpeds.2026.115116","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115116","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate racial and ethnic differences in referral timing, diagnostic evaluation, and treatment of central precocious puberty (CPP) among girls referred to a pediatric endocrinology clinic.</p><p><strong>Study design: </strong>Retrospective chart review of female patients referred for early puberty between January 2010 and January 2023 and subsequently diagnosed with CPP. Extracted data included age at referral, race and ethnicity, insurance type, pubertal stage at first visit, laboratory evaluation, imaging, and treatment. Patients with alternative diagnoses, those referred for other endocrine concerns, or those transferring care with a prior CPP diagnosis were excluded. Statistical analyses were performed using SAS® 9.4.</p><p><strong>Results: </strong>Of 485 referred patients, 259 met inclusion criteria. Referral age did not differ significantly across racial and ethnic groups (P= 0.08), nor did age at endocrinology appointment (P= 0.17). Median time from referral to appointment differed across racial and ethnic groups (P= 0.04), although absolute differences were small. Tanner staging at presentation did not significantly differ (breast stage P= 0.10; pubic hair stage P= 0.09). Diagnostic evaluation, including laboratory testing and imaging, was similar by race and ethnicity. GnRH agonists were prescribed to 44-71% of patients across racial groups without significant difference (P= 0.40), and time from first endocrinology visit to treatment initiation did not differ (P= 0.13). However, cumulative time from referral to treatment initiation differed by race and ethnicity (P= 0.01). Analyses stratified by insurance type and neighborhood deprivation index showed no significant differences in referral timing, evaluation, or treatment.</p><p><strong>Conclusions: </strong>We found no significant racial or ethnic disparities in CPP referral timing, evaluation, or treatment. A small difference in referral-to-appointment time was identified but is likely not clinically meaningful. Further research is needed to determine whether disparities in CPP recognition or referral patterns exist upstream from specialty care.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115116"},"PeriodicalIF":3.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789591","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":"Characterizing Barriers to Living Donor Liver Transplantation for Pediatric Recipients: Qualitative Results from the SOCIAL-Tx Study.","authors":"Morgan Kelly, Saba Ali, Andrea Huerta, Evelyn K Hsu, James E Squires, Kathleen M Campbell, Nitika A Gupta, Shannon M Zielsdorf, Noelle H Ebel, John C Bucuvalas, Jennifer C Lai, Sharad I Wadhwani","doi":"10.1016/j.jpeds.2026.115112","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115112","url":null,"abstract":"<p><strong>Objective: </strong>To characterize barriers and facilitators influencing caregiver decision-making regarding living donor liver transplantation for children with end-stage liver disease.</p><p><strong>Study design: </strong>This qualitative study used semi-structured, in-depth interviews conducted between May 2023 and March 2025 with caregivers of pediatric liver transplant recipients enrolled in the Social & Contextual Impact on Children Undergoing Liver Transplantation study cohort. Interviews were recorded and professionally transcribed, then independently coded by 3 reviewers using a codebook informed by the Capability, Opportunity, Motivation - Behavior model, an implementation science framework. Codes were compared and reconciled to generate themes.</p><p><strong>Results: </strong>Eighteen caregivers participated; 50% reported household incomes <150% of the federal poverty level. Seven themes emerged: (1) insufficient time to comprehend transplant options, (2) perceived or actual lack of eligible donors in caregiver's social network, (3) concern about donor health consequences, (4) challenge of being both a caregiver and donor, (5) discordance between discomfort asking others to donate and response received, (6) limited knowledge about differences between whole and split liver, and (7) the appeal of flexible surgical scheduling offered by living donor liver transplantation. These themes highlight the interplay between cognitive, social, and practical factors influencing pursuit of living donation.</p><p><strong>Conclusions: </strong>Strategies to support decision making about living donor liver transplantation should include counseling about the procedure's benefits early in the transplant evaluation process, helping identify non-directed donors and reducing the caregiving burden during the donor recovery period. Such efforts should prioritize under-resourced families to enhance equitable outcomes for children with end-stage liver disease.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115112"},"PeriodicalIF":3.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789568","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":"Neonatal Pulse Oximetry Accuracy and Disparities by Skin Pigmentation (NeoPODS): A Prospective Study.","authors":"Heather Siefkes, Ira Holla, Evan Giusto, Daniel Tancredi, Satyan Lakshminrusimha","doi":"10.1016/j.jpeds.2026.115114","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115114","url":null,"abstract":"<p><strong>Objective: </strong>To assess pulse oximetry saturation (SpO₂₎ to arterial oxygen saturation (SaO₂) bias relative to skin pigmentation in newborns and to address potentially occult hypoxemia, defined as SaO₂ lower than SpO₂.</p><p><strong>Study design: </strong>We conducted a prospective, diagnostic accuracy study at 2 tertiary neonatal intensive care units between 2022-2025 to assess SpO₂-SaO₂ differences in relation to skin pigmentation in newborns. Newborns younger than 10 postnatal days with an arterial catheter undergoing an arterial blood gas collection were enrolled. A pulse oximeter was placed on the extremity corresponding to the arterial sampling site, and SpO₂ values were recorded during blood gas collection. Skin pigmentation was measured noninvasively using individual typology angle (ITA), melanin index, and visual assessments. Mean SpO₂ was calculated from the 30 seconds immediately preceding arterial sampling or from the most stable 30-second average when timestamps were unavailable and compared with SaO₂ to calculate SpO₂-SaO₂ bias.</p><p><strong>Results: </strong>A total of 136 matched SpO₂-SaO₂ pairs from 70 patients were analyzed, of whom 40% were Black. The overall mean bias was -0·98 ± 2·8% (95% CI -1·4 to -0·52), indicating an underestimation of SaO₂ by SpO₂. Across categorical skin-pigmentation measures and race, no statistically significant differences in SpO₂-SaO₂ bias were observed. When analyzed continuously, bias became less negative with lighter skin pigmentation for both ITA and melanin index, reaching significance only for ITA when analyses were restricted to the first measurement per patient (slope +0·016 per ITA unit, 95% CI 0·001-0·032, p=0·041). Occult hypoxemia was rare, occurring in one newborn with light skin pigmentation.</p><p><strong>Conclusion: </strong>In this prospective neonatal study with tightly paired measurements, SpO₂ slightly underestimated SaO₂ but did not demonstrate clinically significant disparities across skin pigmentation.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115114"},"PeriodicalIF":3.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789620","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 Hemp-Derived Cannabinoid and Δ9-THC Exposures: A National Poison Data Study.","authors":"Bernard Weigel, Michael Wahl","doi":"10.1016/j.jpeds.2026.115113","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115113","url":null,"abstract":"<p><strong>Objective: </strong>To characterize unintentional pediatric exposures to hemp-derived cannabinoids (eg, Δ8-tetrahydrocannabinol [THC], Δ10-THC, THC-O) and evaluate how these exposures compare with those following Δ9-THC, the primary psychoactive component of cannabis.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the National Poison Data System (NPDS) for single-substance exposures to cannabis edibles reported to contain either Δ9-THC or to hemp-derived cannabinoids in children ≤5 years from January 1, 2023, to December 31, 2024. Clinical effects, interventions, and outcomes were compared using chi-square tests.</p><p><strong>Results: </strong>During the study period, 9,667 Δ9-THC and 2,169 hemp-derived cannabinoid cases were identified. In univariate analyses, hemp-derived cannabinoid ingestions were associated with higher rates of respiratory depression (5.9% vs 4.6%; p=0.01) and hypotension (3.87% vs 2.97%; p=0.03) compared with Δ9-THC exposures. Vasopressor use was more frequent in the hemp-derived cannabinoid group (0.37% vs 0.13%; p=0.02), yet rates of central nervous system depression, seizures, and intubation were similar. Children exposed to hemp-derived cannabinoids had higher critical care admission (11.3% vs 8.58%; p<0.001) and overall admission rates (28.35% vs 26.13%; p=0.03). No deaths were reported.</p><p><strong>Conclusions: </strong>Pediatric exposures to hemp-derived cannabinoids were associated with similar or greater clinical severity and healthcare utilization than Δ9-THC exposures. The lack of dose regulation for hemp-derived products may contribute to these findings. Prospective studies capturing dose data are needed to clarify risk and inform policy.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115113"},"PeriodicalIF":3.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789608","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":"BCG Scar Reactivation in Kawasaki Disease.","authors":"Katherine Innis","doi":"10.1016/j.jpeds.2026.115106","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115106","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115106"},"PeriodicalIF":3.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724905","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":"Characteristics of Transient Elastography for Hepatic Steatosis and Fibrosis in Children Undergoing Liver Biopsy.","authors":"Jonathan B Steinman, Ngoc Duong, Ivette Partida, Celine Bien-Aime, Wei Shen, Christine K Lee, Ladan A Fazlollahi, Helen E Remotti, Utpal B Pajvani, Jeff Goldsmith, Jennifer A Woo Baidal","doi":"10.1016/j.jpeds.2026.115107","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115107","url":null,"abstract":"<p><strong>Objective: </strong>To determine the diagnostic performance of vibration controlled transient elastography (VCTE) measured the same day as liver biopsy in screening and risk stratification of steatosis and fibrosis in children and adolescents.</p><p><strong>Study design: </strong>We compared VCTE measures of hepatic steatosis and fibrosis to liver biopsy histology as the reference standard. Sequential patients undergoing liver biopsy in a hospital-based pediatric gastroenterology practice were included. In primary analyses, we determined area under the receiver operating characteristic (AUC), sensitivity, and specificity for VCTE-derived measures of steatosis and fibrosis. In post hoc subgroup analyses, we examined VCTE measures of steatosis and fibrosis among patients according to MASLD diagnosis.</p><p><strong>Results: </strong>Among 145 children, with mean age 13.6 years (standard deviation: 5.1 years), VCTE measures of any steatosis (≥5%) showed AUC 0.89 (95% CI: 0.83-0.94), sensitivity 0.90 (95% CI: 0.79-0.97), and specificity 0.74 (95% CI: 0.64-0.83). VCTE measures for fibrosis stage ≥ F2 had AUC 0.71 (0.59-0.82), sensitivity 0.75 (0.53-0.90), and specificity 0.63 (0.54-0.72). In post hoc subgroup analyses among the subgroup of 37 patients with MASLD, VCTE had low ability to detect higher grades of steatosis (AUC 0.61 for ≥ S2) and low ability to detect clinically meaningful fibrosis (AUC 0.56 for ≥ F2).</p><p><strong>Conclusions: </strong>In the overall cohort, VCTE measurements on the same day as liver biopsy showed moderate ability to detect steatosis and limited ability to detect F2 fibrosis. Diagnostic discrimination for steatosis and fibrosis was low among the subgroup with MASLD. Disease-specific studies, rather than heterogeneous cohorts of mixed disease types, are needed to advance clinical implementation of non-invasive steatosis and fibrosis measures.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115107"},"PeriodicalIF":3.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724924","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":"Association of Parenting Stress in Early Childhood with Emotional Health and Resilience of Young Adults with Congenital Heart Disease.","authors":"Elizabeth A Herrup, Amanda J Shillingford, J William Gaynor, Colleen F B Driscoll, Lyla Hampton, Bingqing Zhang, Keith Baxelbaum, Nancy Burnham","doi":"10.1016/j.jpeds.2026.115110","DOIUrl":"10.1016/j.jpeds.2026.115110","url":null,"abstract":"<p><strong>Objective: </strong>To describe the association between parenting stress levels during early childhood and subsequent emotional health outcomes and resilience of their children with congenital heart disease (CHD) as young adults.</p><p><strong>Study design: </strong>This prospective cohort study included 202 dyads of young adults with CHD and their caregivers. The young adults had undergone surgery with cardiopulmonary bypass (CPB) at < 6 months of life and were enrolled in a longitudinal study of neurodevelopmental outcomes in CHD. Resilience and general health status of the young adults were evaluated using self-report standardized questionnaires (RS-14 and SF-36). Parenting stress in the preschool period was assessed using the Parenting Stress Index (PSI), completed by caregivers.</p><p><strong>Results: </strong>An underlying mental health condition was self-reported by 120 (59%) of the young adults. Median PSI score (PSI total score = 58; IQR 46.25-71) indicated normal parenting stress levels. Mean SF-36 score (46, SD 11) was just below general population average (50), and mean RS-14 score (77, SD14) was similar to population average (76). Higher parenting stress was associated with lower young adults' resilience, with a unit increase in PSI total score associated with 0.14 (95% CI 0.02 - 0.26) decrease in RS-14 total score.</p><p><strong>Conclusions: </strong>Higher reported parenting stress during early childhood was associated with lower self-reported resilience in young adulthood for patients with CHD. This suggests that identification of an at-risk population early in life is possible and may provide an opportunity for targeted family-based interventions to improve psychosocial development with increased resilience.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115110"},"PeriodicalIF":3.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724886","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}