Journal of Pediatrics最新文献

{"title":"Association of a Count of Inpatient Morbidities with Two-Year Outcomes among Infants Born Extremely Preterm.","authors":"Rebecca A Dorner, Lei Li, Sara B DeMauro, Barbara Schmidt, Sahar Z Zangeneh, Yvonne Vaucher, Myra H Wyckoff, Susan Hintz, Waldemar A Carlo, Kathryn E Gustafson, Abhik Das, Anup Katheria","doi":"10.1016/j.jpeds.2024.114428","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114428","url":null,"abstract":"<p><strong>Objective: </strong>To determine if number of neonatal morbidities is associated with death or severe neurodevelopmental impairment (sNDI) among infants born extremely preterm who survived to 36 weeks' postmenstrual age (PMA).</p><p><strong>Study design: </strong>This is a retrospective cohort analysis of prospectively collected data from 15 NICHD Neonatal Research Network (NRN) centers. Neonatal morbidities and 2-year outcomes were examined for 3794 infants born at 22 to 26 weeks' gestation from 2014 through 2019 who survived to 36 weeks' PMA.</p><p><strong>Results: </strong>Serious brain injury (SBI), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP) had the strongest bivariate associations with death or sNDI: odds ratios (ORs, 95% confidence Interval [CI] )3.96 (3.39 , 4.64), 3.41 (2.94 , 3.95), and 2.66 (2.28 , 3.11), respectively. A morbidity count variable was constructed using these morbidities. The estimated (ORs and 95% CI for death or sNDI with any 1, any 2, or all 3 of these morbidities, adjusted for maternal and infant characteristics and hospital of birth, increased from 2.75 (2.25, 3.37) to 6.10 (4.83, 7.70) to 12.90 (9.07, 18.36), respectively. Corresponding rates of late death or sNDI with none, any 1, any 2, and all 3 morbidities were 12.6%, 30.3%, 51.9%, and 69.9%, respectively. The estimated logistic model produced predictions of death or sNDI with moderate discrimination (C-statistic [95% CI]: 0.765 [0.749, 0.782]) and good calibration (Intercept[CITL]= -0.004, slope=1.026).</p><p><strong>Conclusions: </strong>Among infants born extremely preterm who survived to 36 weeks' PMA, a count of SBI, BPD, and severe ROP predicts death or sNDI.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114428"},"PeriodicalIF":3.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792188","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":"Inhaled Nitric Oxide Treatment of Early Pulmonary Hypertension to Reduce the Risk of Death or Bronchopulmonary Dysplasia in Infants Born Extremely Preterm: A Masked Randomized Controlled Trial.","authors":"Hussnain Mirza, Jorge Garcia, Matthew Zussman, Rajan Wadhawan, Julie Pepe, William Oh","doi":"10.1016/j.jpeds.2024.114427","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114427","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether inhaled nitric oxide (iNO) treatment of early pulmonary hypertension (PH) would decrease the risk of death or bronchopulmonary dysplasia (BPD) among infants born extremely preterm.</p><p><strong>Study design: </strong>This was a single-center, masked, randomized controlled trial involving infants born at <29 weeks' gestation and requiring positive pressure ventilation. Exclusion criteria included infants of COVID-19 positive mothers, large patent ductus arteriosus with left to right shunting, left ventricle dysfunction (ejection fraction <40%), significant congenital anomalies/genetic disorders or iNO treatment by clinicians prior to the study echocardiogram. Initial echocardiogram was performed at 72+24 hours of life to randomize infants with early PH into 2 study arms (iNO vs placebo). Serial echocardiograms were performed every 24-48 hours, up to 14 days of life. Treatment was weaned until PH resolved (responders) or if no improvement was documented >72-hours (non-responders). Primary outcome was death or BPD at 36-weeks postmenstrual age.</p><p><strong>Results: </strong>From July 2019 to October 2023, 683 eligible infants were admitted. We excluded 88 infants; 413 mothers declined consent or were not approached. iNO treatment was clinically started for 51 infants due to hypoxic respiratory failure. Screening echocardiograms were completed for 180 infants; of these, 32 infants with early PH were randomized to iNO or placebo groups. After a planned interim analysis, termination of the trial was recommended by the Data Safety Monitoring Committee because of futility. Conclusion iNO treatment does not reduce the risk of BPD or death among extremely preterm infants with echocardiographic evidence of early pulmonary hypertension without hypoxic respiratory failure.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114427"},"PeriodicalIF":3.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792237","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":"Clinical Guidelines for Management of Infants Born before 25 Weeks of Gestation: How Representative Is the Current Evidence?","authors":"Stacey Peart, Mia Kahvo, Tugba Alarcon-Martinez, Kate Hodgson, Helen S Eger, Susan Donath, Louise S Owen, Peter Graham Davis, Charles C Roehr, Brett J Manley","doi":"10.1016/j.jpeds.2024.114423","DOIUrl":"10.1016/j.jpeds.2024.114423","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether management guidelines for infants born extremely preterm are representative for those infants <25 weeks of gestation.</p><p><strong>Study design: </strong>Three guidelines were reviewed: the 2022 European Consensus Guidelines on the Management of Respiratory Distress Syndrome, the 2017 American Academy of Pediatrics Guidelines for Perinatal Care, and the 2020/2021 International Liaison Committee on Resuscitation guidelines. All referenced studies for overlapping recommendations were reviewed. Data extracted included the total number and proportion of infants <25 weeks of gestation in the original articles referred in the guidelines. Where the exact number of infants <25 weeks of gestation was unobtainable, this was conservatively estimated by statistical deduction.</p><p><strong>Results: </strong>Eight recommendations were included in 2 or more guidelines: (1) antenatal corticosteroids, (2) antenatal magnesium sulfate, (3) delayed cord clamping, (4) thermoregulation at birth, (5) initial oxygen concentration at birth, (6) continuous positive airway pressure, (7) surfactant, and (8) parenteral nutrition. In total, 519 studies (n = 409 986) informed these 8 recommendations, of which 335 (64.5%) were randomized controlled trials (n = 78 325). Across all studies, an estimated 59 360 (14.5%) infants were <25 weeks of gestation. Within randomized controlled trials alone, an estimated 5873 (7.5%) infants were <25 weeks of gestation. A total of 196 (37.8%) studies did not include any infants <25 weeks of gestation.</p><p><strong>Conclusions: </strong>Infants born <25 weeks of gestation are not well-represented in the evidence used to develop major clinical guidelines for infants born extremely preterm. Future studies should provide evidence for this population as a distinct cohort.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114423"},"PeriodicalIF":3.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755788","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":"Long-Term Symptoms in Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome after Tonsillectomy.","authors":"Tor Moberg, Karin Rydenman, Stefan Berg, Anders Fasth, Per Wekell","doi":"10.1016/j.jpeds.2024.114424","DOIUrl":"10.1016/j.jpeds.2024.114424","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the initial and long-term clinical course of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome after tonsillectomy regarding fever episodes and nonfebrile PFAPA-related symptoms.</p><p><strong>Study design: </strong>An observational cohort study with retrospective and cross-sectional data based on 86 of 101 patients who underwent tonsillectomy for PFAPA between January 2006 and March 2020 from a cohort of 336 patients diagnosed with PFAPA as children. Data were collected by structured telephone interviews and review of medical records. Parents were interviewed regarding initial response to tonsillectomy and the clinical course following tonsillectomy. Patients, if ≥18 years old, or parents, if patients were younger, were interviewed regarding symptoms present at the time of this long-term follow-up study.</p><p><strong>Results: </strong>Six months after tonsillectomy, 45 of 86 participants (54%) had no symptoms of PFAPA, 19 (22%) had only nonfebrile PFAPA-related symptoms, 17 (20%) had ongoing but fewer or milder fever episodes, 1 (1%) had ongoing febrile episodes without improvement, and 4 (5%) had missing data because parents were unavailable. In 10 of 45 patients with initial remission, fever episodes reappeared 0.5-4.5 years after tonsillectomy. At long-term follow-up (median 8.8 years [range 2.8-16.1 years] after tonsillectomy), 54 of 86 (63%) had no symptoms of PFAPA, 15 (17%) had febrile episodes, generally with longer intervals between flares than before tonsillectomy, and 17 (20%) had nonfebrile PFAPA-related symptoms.</p><p><strong>Conclusions: </strong>While PFAPA symptoms resolve or are milder post-tonsillectomy among most of the patients, the long-term outcomes showing residual symptoms among a substantial minority should be considered when evaluating tonsillectomy as a treatment option for PFAPA. Increased awareness of persistent symptoms after tonsillectomy may improve understanding and health care for these patients.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114424"},"PeriodicalIF":3.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755812","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":"SOX17-Associated Pulmonary Hypertension in Children: A Distinct Developmental and Clinical Syndrome.","authors":"Mary P Mullen, D Dunbar Ivy, Nidhy P Varghese, Abbey J Winant, Nahir Cortes-Santiago, Sara O Vargas, Diego Porres, Nicola Maschietto, Paul J Critser, Russel Hirsch, Catherine M Avitabile, Rachel K Hopper, Benjamin S Frank, Ryan D Coleman, Pankaj B Agrawal, Jill A Madden, Amy E Roberts, Shane L Collins, J Usha Raj, Eric D Austin, Wendy K Chung, Steven H Abman","doi":"10.1016/j.jpeds.2024.114422","DOIUrl":"10.1016/j.jpeds.2024.114422","url":null,"abstract":"<p><strong>Objective: </strong>To characterize clinical, hemodynamic, imaging, and pathologic findings in children with pulmonary arterial hypertension (PAH) and variants in SRY-box transcription factor 17 (SOX17), a novel risk gene linked to heritable and congenital heart disease-associated PAH.</p><p><strong>Study design: </strong>We assembled a multi-institutional cohort of children with PAH and SOX17 variants enrolled in the Pediatric Pulmonary Hypertension Network (PPHNet) and other registries. Subjects were identified through exome and PAH gene panel sequencing. Data were collected from registries and retrospective chart review.</p><p><strong>Results: </strong>We identified 13 children (8 female, 5 male) aged 1.6-16 years at diagnosis with SOX17 variants and PAH. Seven patients had atrial septal defects and 2 had patent ductus arteriosus. At diagnostic cardiac catheterization, patients had severely elevated mean pulmonary artery (PA) pressure (mean 78, range 47-124 mmHg) and markedly elevated indexed pulmonary vascular resistance (mean 25.9, range 4.9-55 WU∗m²). No patients responded to acute vasodilator testing. Catheter and computed tomography angiography imaging demonstrated atypical PA anatomy including severely dilated main pulmonary arteries, lack of tapering in third and fourth order pulmonary arteries, tortuous 'corkscrewing' pulmonary arteries, and abnormal capillary 'blush.' Several children had PA stenoses and 2 had systemic arterial abnormalities. Histologic examination of explanted lungs from 3 patients disclosed plexiform arteriopathy and extensive aneurysmal dilation of alveolar septal capillaries.</p><p><strong>Conclusions: </strong>SOX17-associated PAH is a distinctive genetic syndrome characterized by early onset severe PAH, extensive pulmonary vascular abnormalities, and high prevalence of congenital heart disease with intracardiac and interarterial shunts, suggesting a role for SOX17 in pulmonary vascular development.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114422"},"PeriodicalIF":3.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740484","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":"Severity of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 Diminished During Successive Waves of the COVID-19 Pandemic: Data from a Nationwide German Survey.","authors":"Florens Lohrmann, Maren Doenhardt, Natalie Diffloth, André Jakob, Anton Hospach, Dominik T Schneider, Andreas Trotter, Jürgen Brunner, Sarah Goretzki, Stefan Arens, Michael Rank, René Mauer, Jakob Armann, Reinhard Berner, Markus Hufnagel","doi":"10.1016/j.jpeds.2024.114419","DOIUrl":"10.1016/j.jpeds.2024.114419","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate how the clinical presentation of Pediatric Inflammatory Multisystem Syndrome temporally associated with Severe Acute Respiratory Syndrome-related Coronavirus 2 (PIMS-TS) was influenced by the successive variants of concern (VOC) and patient age.</p><p><strong>Study design: </strong>A nationwide PIMS-TS registry was established in Germany in May 2020, shortly after the first cases were described in the US and United Kingdom. The registry captured information on patient characteristics, clinical course, laboratory findings, imaging, and outcome. All pediatric hospitals in Germany, along with one in Austria, were invited to participate. Between March 18, 2020, and April 30, 2023, 920 cases were reported.</p><p><strong>Results: </strong>By examining a combination of data on clinical features, laboratory findings, treatment, imaging results, and outcomes, our analysis demonstrated disease severity to have continuously declined over the course of the Wildtype, Alpha, Delta, and Omicron waves. Based on clinical symptoms, laboratory and diagnostic findings, and intensive care unit admission rates, older children, irrespective of the related VOC, were shown to experience more severe, acute PIMS-TS; however, they had lower rates of coronary aneurysm.</p><p><strong>Conclusions: </strong>During the course of COVID-19 pandemic, as each new VOC emerged, PIMS-TS lessened in severity. In parallel, older children came to experience more debilitating disease.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114419"},"PeriodicalIF":3.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741497","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":"Why the Negative? A Reflective Analysis on the Impact of Weekly Vitamin D Supplementation on Acute Respiratory Infections in Young Children.","authors":"Yahong Wang, Yupeng Ruan","doi":"10.1016/j.jpeds.2024.114417","DOIUrl":"10.1016/j.jpeds.2024.114417","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114417"},"PeriodicalIF":3.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695789","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":"Continuous Glucose Monitoring among Infants Born Very Preterm: Evidence for Accuracy in Neonatal Intensive Care.","authors":"Jacopo Bonet, Silvia Guiducci, Giulia Res, Sabrina Brigadoi, Sarbattama Sen, Paolo Montaldo, Elena Priante, Nicola Santoro, Daniele Trevisanuto, Eugenio Baraldi, Chiara Dalla Man, Alfonso Galderisi","doi":"10.1016/j.jpeds.2024.114416","DOIUrl":"10.1016/j.jpeds.2024.114416","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the accuracy of a device for continuous glucose monitoring (CGM) among infants born preterm admitted to the neonatal intensive care unit.</p><p><strong>Study design: </strong>We analyzed paired CGM sensor glucose (SG) and point-of-care blood glucose (BG) measurements collected in infants born at ≤32 weeks of gestation or with a birth weight ≤1500 g. CGM was initiated within 48 hours from birth and maintained for 5 days. BG was performed every 12 hours and used to calibrate the sensor. Measures of CGM accuracy were computed from SG and BG pairs.</p><p><strong>Results: </strong>We included 501 SG-BG paired measurements from 51 infants (age 30.5 weeks [IQR 29.0-31.0 weeks], birth weight 1400 g [IQR 1100-1500 g] with at least 24 hours of CGM data. The mean absolute relative difference (MARD) between SG and point-of-care BG measures was 7.1% [IQR 5.6-9.3], corresponding to a difference of -5.6 mg/dL [95% CI -25 to +14 mg/dl]. The median sensor use was 96 hours [IQR 72-120] with 2.0 [IQR 1.7-2.4] calibrations per day.</p><p><strong>Conclusions: </strong>Accuracy of SG measurements compared with BG measurements appears to be acceptable in a clinical study setting, with a negligible difference between SG and BG. Our data suggest that SG use may be clinically acceptable when the sensor is regularly calibrated.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114416"},"PeriodicalIF":3.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695171","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 to Why the Negative? A Reflective Analysis on the Impact of Weekly Vitamin D Supplementation on Acute Respiratory Infections in Young Children.","authors":"María Loreto Reyes, Cecilia Vizcaya, Catalina Le Roy, Carlos A Camargo, Arturo Borzutzky","doi":"10.1016/j.jpeds.2024.114418","DOIUrl":"10.1016/j.jpeds.2024.114418","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114418"},"PeriodicalIF":3.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695317","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":"Surge of Pediatric Respiratory Tract Infections After the COVID-19 Pandemic and the Concept of \"Immune Debt\".","authors":"Lea Lenglart, Luigi Titomanlio, Zsolt Bognar, Silvia Bressan, Danilo Buonsenso, Tisham De, Ruth Farrugia, Kate Honeyford, Ian K Maconochie, Henriette A Moll, Rianne Oostenbrink, Niccolo Parri, Damian Roland, Esra Akyüz Özkan, Laura Almeida, Ilaria Alberti, François Angoulvant, Zein Assad, Camille Aupiais, Michael Barrett, Romain Basmaci, Dorine Borensztajn, Susana Castanhinha, Antonio Chiaretti, Robert Cohen, Sheena Durnin, Patrick Fitzpatrick, Susanne Greber-Platzer, Romain Guedj, Florian Hey, Lina Jankauskaite, Kristina Keitel, Ines Mascarenhas, Gregorio P Milani, Anna Maria Musolino, Zanda Pučuka, Malin Ryd Rinder, Maria Chiara Supino, Francesca Tirelli, Ruud G Nijman, Naim Ouldali","doi":"10.1016/j.jpeds.2024.114420","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114420","url":null,"abstract":"<p><strong>Objective: </strong>To investigate a dose-response relationship between the magnitude of decrease in pediatric respiratory tract infections (RTI) during the 2020 implementation of non-pharmaceutical interventions (NPI) and the rise thereafter during NPI lifting.</p><p><strong>Study design: </strong>We conducted an interrupted, time-series analysis, based on a multinational surveillance system. All patients <16 years of age coming to medical attention with various symptoms and signs of RTI at 25 pediatric emergency departments from 13 European countries between January 2018 and June 2022 were included. We used generalized additive models to correlate the magnitude of decrease of each RTI during NPI (such as social distancing) implementation and its subsequent increase during NPI lifting. Urinary tract infections (UTI) served as control outcome.</p><p><strong>Results: </strong>528,055 patients were included. We observed reductions in cases during the NPI period, from -76% (95%CI -113;-53) in pneumonia) to -65% (95%CI[-100;-39) for tonsillitis/pharyngitis), followed by strong increases during NPI lifting, from +83% (95%CI 29;150) for tonsillitis/pharyngitis) to +329% (95%CI (149;517) bronchiolitis). For each RTI, we found a significant association between the magnitude of decrease during NPI implementation and the increase during NPI lifting. UTI cases remained stable.</p><p><strong>Conclusions: </strong>The magnitude of increase in RTI observed following NPI lifting was directly correlated to the magnitude of cases' reduction during NPI implementation, suggesting a \"dose-response\" relationship from an \"immune debt\" phenomenon. The likely rebound in RTIs should be expected when implementing and lifting NPI in the future.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114420"},"PeriodicalIF":3.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695465","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}