Journal of Pediatrics最新文献

{"title":"Management Variation in Pediatric Labial Adhesions: A Retrospective Cohort Study","authors":"Riley J. O'Keefe BS,&nbsp;Sarah D. Compton PhD, MPH,&nbsp;Melina L. Dendrinos MD,&nbsp;Monica W. Rosen MD","doi":"10.1016/j.jpeds.2025.114529","DOIUrl":"10.1016/j.jpeds.2025.114529","url":null,"abstract":"<div><h3>Objective</h3><div>To compare treatment and outcome differences between primary care providers (PCPs), pediatric and adolescent gynecologists (PAGs), and pediatric urologists (PURs) in management of labial adhesions (LAs).</div></div><div><h3>Study design</h3><div>This was a retrospective, cohort study of patients aged 0 through 21 presenting for a clinic visit from July 2022 to July 2023 at a single institution, identified by International Classification of Diseases 9th revision/10th revision codes for LA. Management variation was analyzed via cross-tabs with chi-square, Fisher exact test, and two-sample <em>t</em>-tests.</div></div><div><h3>Results</h3><div>The 159 patients meeting inclusion criteria had a median age of 12 months at diagnosis; 81 were managed by a PCP and 78 were referred to a specialist: 41 (52.6%) PUR, 32 (41.0%) PAG, and 5 (6.4%) other specialists. Forty-one patients presented with urinary issues, with no difference in rate of referral to PUR (37.8%), PAG (15.5%), or continued PCP management (46.7%), <em>P</em> = .17. All patients were initially treated nonsurgically. Surgical intervention rates did not differ between PAG and PUR (<em>P</em> = .21). PUR performed sharp adhesiolysis more often than PAG (<em>P</em> = .011), but there was no difference in blunt adhesiolysis rates between PAG and PUR (<em>P</em> = .17). LA recurred postoperatively in 6 (3.8%) patients.</div></div><div><h3>Conclusions</h3><div>These results reiterate the efficacy of nonsurgical treatment for most patients with LA and illustrate minor variation in LA management between PAG and PUR.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"281 ","pages":"Article 114529"},"PeriodicalIF":3.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588254","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":"Outpatient Diuretic Use and Respiratory Outcomes in Children with Bronchopulmonary Dysplasia During the First Three Years of Life","authors":"Julianne R. McGlynn MD ,&nbsp;Amanda Martin BA ,&nbsp;Brianna C. Aoyama MD, MHS ,&nbsp;Sharon A. McGrath-Morrow MD, MBA ,&nbsp;Joseph M. Collaco MD, PhD","doi":"10.1016/j.jpeds.2025.114530","DOIUrl":"10.1016/j.jpeds.2025.114530","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the link between outpatient respiratory outcomes in children with bronchopulmonary dysplasia (BPD) who are prescribed outpatient diuretics vs those who are not at the time of their initial pediatric pulmonary clinic visit.</div></div><div><h3>Study design</h3><div>Patient data were gathered by chart review and validated questionnaires on 1002 children with BPD discharged between 2008 and 2023 seen at the Children's Hospital of Philadelphia and Johns Hopkins Children's Center outpatient pediatric pulmonary clinics.</div></div><div><h3>Results</h3><div>Children prescribed outpatient diuretics (n = 634) at time of first pulmonary appointment were more likely to have severe BPD and require home supplemental oxygen. Outpatient diuretic therapy was associated with initial hospital discharge at an older age, but an earlier first pulmonary clinic visit. Children between 0 and 3 years prescribed 1 or 2 diuretics were less likely to be readmitted to the hospital for respiratory reasons than those not on diuretics. There was no difference in health care utilization for those on three diuretics compared with those not on diuretics. Children weaned off diuretics by a caregiver compared with a health care provider had higher odds of being readmitted to the hospital for respiratory reasons.</div></div><div><h3>Conclusions</h3><div>For children with BPD, a modest reduction in rehospitalization was associated with being on 1 or 2 diuretics at their initial outpatient visit. However, no difference in chronic respiratory symptoms was observed between children receiving diuretics and those who were not. Caregiver-led weaning of diuretics was associated with a higher risk of rehospitalization compared with weaning by the health care provider.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"281 ","pages":"Article 114530"},"PeriodicalIF":3.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588276","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 National Institutes of Health and Industry-Funded Clinical Trials Versus Pediatric Burden of Disease: United States, 2015-2020","authors":"Ansh Goyal MD ,&nbsp;Chiu-Lun Chang MD ,&nbsp;Zofia Zdanowicz MD ,&nbsp;Alyssa Brown MD ,&nbsp;Susanna A. McColley MD, FAAP ,&nbsp;Matthew M. Davis MD, MAPP","doi":"10.1016/j.jpeds.2025.114525","DOIUrl":"10.1016/j.jpeds.2025.114525","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate how the number of pediatric clinical trials, as a proxy for industry and National Institutes of Health (NIH) research priorities, compared with population-level burden of childhood disease in the United States.</div></div><div><h3>Study design</h3><div>Cross-sectional study evaluating associations between initiated clinical trials funded by industry or the NIH and pediatric burden of disease in the US. Disease burden was measured as deaths, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability.</div></div><div><h3>Results</h3><div>From 2015 through 2020, 3047 clinical trials were initiated with industry funding, compared with 1480 clinical trials initiated with NIH funding. The leading 20 disease categories with the greatest burden of disease by DALYs accounted for 79.4% of total DALYs; these 20 categories were the focus of 43.5% of all industry-funded trials and 41.9% of NIH-funded trials during the study period. Industry-sponsored pediatric clinical trials had a moderately strong monotonic relationship with DALYs (Spearman rank order coefficient [r_s] = 0.59), compared with r_s = 0.44 for NIH-funded clinical trials. Disease burden as measured by deaths, years of life lost, and years lived with disability demonstrated a broad range of correlations with clinical trial initiation, with r_s values ranging from 0.18 to 0.48. The least prioritized high-burden disease categories by both industry and NIH were neonatal disorders, congenital birth defects, and asthma.</div></div><div><h3>Conclusions</h3><div>Industry-sponsored and government-funded pediatric clinical trials in the US are variably associated with pediatric disease burden across measures of disability and mortality. Underprioritized pediatric diseases with significant burden of disease deserve special consideration for clinical trials through future legislative attention and corresponding funding.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"281 ","pages":"Article 114525"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568838","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 Natural History of Congenital Hepatic Hemangiomas","authors":"Claire A. Ostertag-Hill MD ,&nbsp;R. Dawn Fevurly MD ,&nbsp;Ann M. Kulungowski MD ,&nbsp;Emily R. Christison-Lagay MD ,&nbsp;Anna M. McGuire MD ,&nbsp;Kristy L. Rialon MD ,&nbsp;Eileen M. Duggan MD ,&nbsp;Rudy Murillo MD ,&nbsp;David Zurakowski PhD ,&nbsp;Steven J. Staffa MS ,&nbsp;Ahmad I. Alomari MD ,&nbsp;Harry P.W. Kozakewich MD ,&nbsp;Alyaa Al-Ibraheemi MD ,&nbsp;Steven J. Fishman MD ,&nbsp;Belinda H. Dickie MD, PhD","doi":"10.1016/j.jpeds.2025.114523","DOIUrl":"10.1016/j.jpeds.2025.114523","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the clinical presentation, radiologic and histologic findings, and management options for congenital hepatic hemangioma (HH) with a focus on describing its natural history and rate of involution.</div></div><div><h3>Study design</h3><div>Retrospective review of patients in our HH registry with a congenital HH born between 2004 and 2022 was performed. HH volumes were calculated using the formula for an ellipsoid. Multiple analyses of HH volume change were performed using nonlinear regression with generalized estimating equations, Kaplan-Meier curves, and logrank test.</div></div><div><h3>Results</h3><div>We identified 96 infants with a congenital HH. Of these, 32% were diagnosed prenatally, 23% developed heart failure, and 23% developed respiratory failure. On average, patients demonstrated 43% residual HH volume at 12 months (95% confidence interval: 27%-60%) and 16% residual volume at 24 months (95% confidence interval: 0%-35%). No difference in time to 50% HH volume reduction between patients with and without medical therapy was observed (<em>P</em> = .894).</div></div><div><h3>Conclusion</h3><div>Congenital HH represents the hepatic counterpart of the cutaneous congenital hemangioma and is clinically, histologically, and radiographically distinct from infantile HH. Most lesions reach &gt;80% involution by 24 months of age with no differences in time to involution observed with medical therapy. A clear understanding of the clinical behavior and evolution of congenital HH is critical to early recognition of associated morbidity and prompt review of an incorrect diagnosis.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"281 ","pages":"Article 114523"},"PeriodicalIF":3.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538179","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":"Associations of Bronchopulmonary Dysplasia and Infection with School-Age Brain Development in Children Born Preterm","authors":"Caroline Kim BASc ,&nbsp;Steven Ufkes MSc ,&nbsp;Ting Guo PhD ,&nbsp;Vann Chau MD ,&nbsp;Anne Synnes MDCM, MHSc ,&nbsp;Ruth E. Grunau PhD ,&nbsp;Steven P. Miller MDCM, MAS","doi":"10.1016/j.jpeds.2025.114524","DOIUrl":"10.1016/j.jpeds.2025.114524","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association of bronchopulmonary dysplasia (BPD) and culture-positive infection with neurodevelopment and white matter maturation at 8 years of age in children born preterm.</div></div><div><h3>Study design</h3><div>Prospective cohort study of 164 children born at 24-32 weeks of gestation followed to 8 years of age (89 male, median [IQR] age: 8.24 [8.07-8.58] years). At age 8, IQ (Weschler Abbreviated Scale of Intelligence, second Ed), working memory (Wechsler Intelligence Scale for Children, fifth Ed), visual-motor (Beery-Buktenica Developmental Test of Visual-Motor Integration sixth Ed), and motor outcomes (Movement Assessment Battery for Children-2) were assessed. Diffusion tensor imaging and tract-based spatial statistics were used to assess fractional anisotropy (FA).</div></div><div><h3>Results</h3><div>Fifty of 164 children had BPD and 72/164 had culture-positive infection. At 8 years, BPD was associated with a 9.8-point decrease in motor (CI −17.9 to −1.8, <em>P</em> = .02) and 6.0-point decrease in visual-motor scores (CI −10.5 to −1.5, <em>P</em> = .009), whereas infection was associated with a 6.3-point decrease in IQ (CI −12.3 to −0.3, <em>P</em> = .04), after adjusting for gestational age and white matter injury volume. BPD was associated with left hemisphere-dominant FA reductions, which were associated with worse motor (<em>P</em> = .000006) and visual-motor (<em>P</em> = .00005) outcomes, whereas infection was associated with bilateral FA reductions, which were associated with lower IQ scores (<em>P</em> = .03) and poorer working memory (<em>P</em> = .01) at 8 years.</div></div><div><h3>Conclusions</h3><div>This cohort study of children born very preterm suggests that BPD and culture-positive infection are distinctly associated with impaired white-matter development and poor neurodevelopmental outcomes. These findings imply neonatal illnesses impact the brain nonuniformly, suggesting opportunities for targeted intervention.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"281 ","pages":"Article 114524"},"PeriodicalIF":3.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538178","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":"Caveat Emptor for Point-of-Care Glucose Testing for Newborns","authors":"James F. Padbury MD","doi":"10.1016/j.jpeds.2025.114498","DOIUrl":"10.1016/j.jpeds.2025.114498","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114498"},"PeriodicalIF":3.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474232","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":"Safe Sleep for Infants Born Preterm","authors":"Raye-Ann deRegnier MD","doi":"10.1016/j.jpeds.2025.114497","DOIUrl":"10.1016/j.jpeds.2025.114497","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114497"},"PeriodicalIF":3.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474364","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":"Information for Readers","authors":"","doi":"10.1016/S0022-3476(25)00028-9","DOIUrl":"10.1016/S0022-3476(25)00028-9","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114488"},"PeriodicalIF":3.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474361","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":"Can We Outsource the Teaching of Pediatric Dermatology?","authors":"Robert A. Dudas MD","doi":"10.1016/j.jpeds.2025.114496","DOIUrl":"10.1016/j.jpeds.2025.114496","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114496"},"PeriodicalIF":3.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474363","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":"Prediction of Neurodevelopmental Outcomes at 18 to 22 Months Using the Numerical Sarnat Score Compared with Modified Sarnat Staging in Infants with Moderate to Severe Hypoxic-Ischemic Encephalopathy","authors":"Girija Natarajan MD ,&nbsp;Scott A. McDonald BS ,&nbsp;Seetha Shankaran MD ,&nbsp;Abbot R. Laptook MD ,&nbsp;Sonia Bonifacio MD ,&nbsp;Elizabeth K. Sewell MD ,&nbsp;Lina Chalak MD ,&nbsp;NICHD Neonatal Research Network","doi":"10.1016/j.jpeds.2025.114522","DOIUrl":"10.1016/j.jpeds.2025.114522","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association of a numerical Sarnat score (NSS) and modified Sarnat staging among newborn infants with moderate/severe hypoxic-ischemic encephalopathy and their neurodevelopmental outcomes at 18-22 months.</div></div><div><h3>Study design</h3><div>This secondary analysis included participants with gestational age ≥36 weeks and moderate/severe hypoxic-ischemic encephalopathy (HIE) from the Induced Hypothermia and Optimizing Cooling trials. Early (&lt;6 hours age) neurologic examinations were performed by trained examiners to categorize HIE severity by modified Sarnat staging. The NSS was calculated by summing abnormal scores (2 for moderate, 3 for severe) in the 6 examination categories. The primary outcome was death or moderate/severe disability. Statistical analysis included logistic regression, adjusting for center, trial, and cooling group, and linear regression for continuous scales.</div></div><div><h3>Results</h3><div>The cohort (n = 528) included infants with 71% moderate and 29% severe HIE (37% Induced Hypothermia and 63% Optimizing Cooling participants). Median (IQR) NSS of infants with moderate and severe HIE were 11 (9-13) and 16 (16-17), respectively. There were significant associations among NSS, NSS tertiles, and modified Sarnat staging and death or disability, but there were no differences found in their area-under-the-curve estimates. Similar to modified Sarnat staging, NSS showed significant associations with Bayley-III cognitive, language, and motor scores and Bayley-II mental and psychomotor developmental indices.</div></div><div><h3>Conclusion</h3><div>Among infants with moderate or severe HIE, the NSS did not improve the predictive accuracy for death or disability at 18-22 months of age, compared with modified Sarnat staging performed in the initial 6 hours after birth by trained examiners.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"281 ","pages":"Article 114522"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484686","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}