Journal of Pediatrics最新文献

{"title":"Development and Evaluation of Pediatric Acute Care Hospital Referral Regions in Eight States","authors":"Allan M. Joseph MD, MPH ,&nbsp;John S. Minturn MAS ,&nbsp;Kristen S. Kurland BA ,&nbsp;Billie S. Davis PhD ,&nbsp;Jeremy M. Kahn MD, MS","doi":"10.1016/j.jpeds.2024.114371","DOIUrl":"10.1016/j.jpeds.2024.114371","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery and test their utility relative to other regional systems.</div></div><div><h3>Study design</h3><div>We used state-level administrative databases capturing all pediatric acute care in 8 states to construct novel referral regions. We first constructed pediatric hospital service areas (PHSAs) based on 5 837 464 pediatric emergency department encounters. We then aggregated these PHSAs to pediatric hospital referral regions (PHRRs) based on 344 440 pediatric hospitalizations. Finally, we used 3 measures of spatial accuracy (localization index, market share index, and net patient flow) to compare this novel region system with the Dartmouth Atlas, designed originally to study adult specialty care, and the Pittsburgh Atlas, designed originally to study adult acute care.</div></div><div><h3>Results</h3><div>The development procedure resulted in 717 novel PHSAs, which were then aggregated to 55 PHRRs across the included states. Relative to hospital referral regions in the Dartmouth and Pittsburgh Atlases, PHRRs were fewer in number and larger in area and population. PHRRs more accurately captured patterns of pediatric hospitalizations, (eg, mean localization index: 69.1 out of 100, compared with a mean of 58.1 for the Dartmouth Atlas and 62.4 for the Pittsburgh Atlas).</div></div><div><h3>Conclusions</h3><div>The use of regional definitions designed specifically to study pediatric acute care better captures contemporary pediatric acute care delivery than the use of existing regional definitions. Future work should extend these definitions to all US states to enable national analyses of pediatric acute care delivery.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114371"},"PeriodicalIF":3.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481225","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":"Demodicosis in an Immunocompetent Child","authors":"Arezki Izri MD, PhD,&nbsp;Sophie Brun MD, PhD,&nbsp;Gérôme Bohelay MD, PhD,&nbsp;Mohammad Akhoundi PhD","doi":"10.1016/j.jpeds.2024.114336","DOIUrl":"10.1016/j.jpeds.2024.114336","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114336"},"PeriodicalIF":3.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407185","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 Academic Pediatrician-Advocate: A View from Government Relations Officials of United States Freestanding Children's Hospitals.","authors":"Eimaan Anwar, Richard J Chung, Diana Bautista, Lisa J Chamberlain, Debra L Best","doi":"10.1016/j.jpeds.2024.114335","DOIUrl":"10.1016/j.jpeds.2024.114335","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114335"},"PeriodicalIF":3.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402023","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":"Esophageal Atresia with Tracheoesophageal Fistula Is Associated with Consanguinity in the Bedouins of the Negev.","authors":"Raouf Nassar, Baruch Yerushalmi","doi":"10.1016/j.jpeds.2024.114334","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114334","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114334"},"PeriodicalIF":3.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395396","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":"Corrigendum to “A Randomized Trial of Baby Triple P for Preterm Infants: Child Outcomes at 2 Years of Corrected Age”. J Pediatr. 2019;210:48-54","authors":"Paul B. Colditz DPhil (Oxon) ,&nbsp;Roslyn N. Boyd PhD ,&nbsp;Leanne Winter PhD ,&nbsp;Margo Pritchard PhD ,&nbsp;Peter H. Gray MD ,&nbsp;Koa Whittingham PhD ,&nbsp;Michael O’Callaghan MSc ,&nbsp;Luke Jardine MClinEpid ,&nbsp;Peter O’Rourke PhD ,&nbsp;Louise Marquart PhD ,&nbsp;Kylee Forrest DClinPsych ,&nbsp;Carmen Spry PhD ,&nbsp;Matthew R. Sanders PhD","doi":"10.1016/j.jpeds.2024.114293","DOIUrl":"10.1016/j.jpeds.2024.114293","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"275 ","pages":"Article 114293"},"PeriodicalIF":3.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382451","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":"Infants Born at Late Preterm Gestation: Management during the Birth Hospitalization","authors":"Neha S. Joshi MD, MS ,&nbsp;Jochen Profit MD, MPH ,&nbsp;Adam Frymoyer MD ,&nbsp;Valerie J. Flaherman MD, MPH ,&nbsp;Yuan Gu PhD ,&nbsp;Henry C. Lee MD, MS","doi":"10.1016/j.jpeds.2024.114330","DOIUrl":"10.1016/j.jpeds.2024.114330","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the admission practices, frequency of common clinical morbidities, and rates of medical intervention in infants born at 34-36 weeks gestational age (GA, late preterm).</div></div><div><h3>Study design</h3><div>This retrospective, single institution, cohort study analyzed electronic health records of infants born late preterm from 2019 through 2021. Infants with known congenital anomalies necessitating neonatal intensive care unit admission were excluded. Analysis included descriptive and inferential statistics.</div></div><div><h3>Results</h3><div>The study included 1022 infants: 209 (21%) 34 weeks GA, 263 (26%) 35 weeks GA, and 550 (54%) 36 weeks GA. Sixty-three percent of infants at 35 weeks GA and 78% of infants of 36 weeks GA remained in well newborn care throughout the birth hospitalization; infants born at 34 weeks GA were ineligible for well newborn care. The need for respiratory support was 32%, 18%, and 11% in infants of 34, 35, and 36 weeks GA, respectively. Supplemental tube feeds were administered in 55%, 24%, and 8% of infants of 34, 35, and 36 weeks GA, respectively. Most infants born at 34 weeks GA (91%) were placed in an incubator; this was less frequent in infants at 35 (37%) and 36 weeks (16%). Tachypnea, hypoglycemia, and hypothermia were noted in 40%, 61%, and 57% of infants, respectively. A subset of these infants (30% with tachypnea, 23% with hypoglycemia, and 46% with hypothermia) required medical intervention for these abnormalities.</div></div><div><h3>Conclusions</h3><div>This single-center study provides an outlook on the care of infants born late preterm. Multicenter studies can contextualize these findings in order to develop clinical benchmarks and quality markers for this large population of infants.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114330"},"PeriodicalIF":3.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382452","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":"Juvenile Spring Eruption: Twice is Not Nice","authors":"Michelle L. Wang BA,&nbsp;Hayley S. Goldbach MD,&nbsp;Indi Trehan MD, MPH, DTM&H","doi":"10.1016/j.jpeds.2024.114331","DOIUrl":"10.1016/j.jpeds.2024.114331","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114331"},"PeriodicalIF":3.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373589","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":"Liberal Fluid Resuscitation is Associated with Improved Outcomes in Pediatric Acute Pancreatitis","authors":"Nicholas Norris MD ,&nbsp;Peter Farrell MD, MS ,&nbsp;Sherif Ibrahim MD ,&nbsp;Lin Fei PhD ,&nbsp;Qin Sun MPH ,&nbsp;David S. Vitale MD ,&nbsp;Maisam Abu-El-Haija MD, MS","doi":"10.1016/j.jpeds.2024.114329","DOIUrl":"10.1016/j.jpeds.2024.114329","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate outcomes of children from an observational cohort registry of index acute pancreatitis (AP) admissions managed with different types and rates of intravenous fluid therapy.</div></div><div><h3>Study design</h3><div>Patients with index admission of AP between 2013 and 2023 were included. Those who received &gt;1.5x the maintenance intravenous fluid rate were assigned to the liberal fluid group, and patients who received &lt;1.5x maintenance fluids were assigned to the conservative group. Outcomes including intensive care unit admission rate, organ dysfunction, local pancreatic complications, and AP severity were evaluated. Influence of early enteral feeding and fluid composition on outcomes and clinical course were also analyzed.</div></div><div><h3>Results</h3><div>Patients who received liberal fluids were less likely to be admitted or transferred to the intensive care unit compared with those receiving conservative management (OR, 0.32; 95% CI, 0.12-0.80; <em>P</em> = .015). The liberal fluid group with early feeding had the lowest rate of moderate/severe manifestations of AP compared with other combinations of diet and fluid orders. Patients within the liberal fluid group who received the highest fluid rates (&gt;2x maintenance) did not have higher rates of organ dysfunction or severe disease.</div></div><div><h3>Conclusions</h3><div>Children with AP may stand to benefit from liberal fluid therapy and continued diet compared with more conservative fluid resuscitation and nothing by mouth status.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114329"},"PeriodicalIF":3.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367450","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":"Trends in the Diagnosis of Pediatric Venous Thromboembolism and Arterial Ischemic Stroke during the COVID-19 Pandemic: An Administrative Database Study","authors":"Riten Kumar MD, MSc ,&nbsp;Nan Chen MS ,&nbsp;Laura L. Lehman MD, MPH ,&nbsp;Wendy B. London PhD","doi":"10.1016/j.jpeds.2024.114328","DOIUrl":"10.1016/j.jpeds.2024.114328","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate trends in the diagnosis of venous thromboembolism (VTE) and arterial ischemic stroke (AIS), and examine the use of pharmacological thromboprophylaxis during the COVID-19 pandemic.</div></div><div><h3>Study design</h3><div>This retrospective cohort study used the Pediatric Health Information Systems database to investigate patients admitted to a participating hospital between January 1, 2018, and December 31, 2021. International Classification of Diseases, 10th edition codes were used to identify VTE, AIS, and COVID-19. Pharmacy billing codes were used to investigate pharmacological thromboprophylaxis use.</div></div><div><h3>Results</h3><div>1 759 701 unique patients underwent 2 234 135 inpatient admissions. Rate of VTE increased from 84 cases per 10 000 admissions in 2018-2019 to 108 cases per 10 000 admissions in 2020-2021, representing a 28.6% increase (<em>P</em> &lt; .001). In contrast, the rate of AIS remained stable through the study period. When compared with 2018-2019, children diagnosed with VTE during 2020-2021 had longer hospitalizations and were more likely to be admitted to the intensive care unit. When analysis was limited to 2020-2021, a diagnosis code of COVID-19 was associated with a 1.35-fold (95% CI: 1.24-1.45) increase in the odds of VTE diagnosis, but not AIS. Use of pharmacologic thromboprophylaxis increased from 1.5% of hospitalizations in 2018-2019 to 3.0% of hospitalizations in 2020-2021 (<em>P</em> &lt; .001). When evaluating thromboprophylaxis during 2020-2021, a diagnosis code for COVID-19 was associated with an 11-fold (95% CI: 10.86-11.49; <em>P</em> &lt; .001) increase in the utilization of pharmacological thromboprophylaxis.</div></div><div><h3>Conclusions</h3><div>This study found an increase in the rate of VTE among hospitalized children during the pandemic. A diagnosis of COVID-19 was associated with a modest increase in odds of VTE diagnosis, which occurred despite increased use of pharmacological thromboprophylaxis.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114328"},"PeriodicalIF":3.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367451","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 Features of Typically Developing Children With and Without Prenatal Alcohol Exposure.","authors":"Philip A May, Barbara Tabachnick, Julie M Hasken, Anna-Susan Marais, Marlene M de Vries, Wendy O Kalberg, David Buckley, Melanie Manning, Luther K Robinson, Charles D H Parry, Soraya Seedat, H Eugene Hoyme","doi":"10.1016/j.jpeds.2024.114327","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114327","url":null,"abstract":"<p><strong>Objective: </strong>To determine if prenatal alcohol exposure (PAE) affected physical and cognitive/behavioral outcomes in apparently typically developing, first-grade children.</p><p><strong>Study design: </strong>Three groups were compared: children with fetal alcohol spectrum disorders (FASD); children with PAE without FASD; and children without PAE.</p><p><strong>Results: </strong>The three groups were significantly different on most physical traits and fewer neurodevelopmental traits. Two-group comparisons of exposed and unexposed, non-FASD groups were statistically different on: height, weight, head circumference (OFC), body mass index (BMI), and palpebral fissure length (PFL). Neurobehavioral outcomes were significant in three-group, but not two-group, comparisons. Few sex differences were observed; however, sex ratios indicated fewer male offspring in first grade among women who consumed 6+ drinks per occasion during pregnancy. For weight, OFC, BMI, age, rural residence, and drinking measures, mothers of exposed children without FASD were intermediaries between, and significantly different from, the other maternal groups. Adjusted for socioeconomic covariates, multivariate analysis of covariance (MANCOVA), three-group comparisons were significantly different for cognitive/behavioral variables (p<.001); however, two-group neurobehavior comparisons for children without FASD were not significant (p>.05). Physical trait MANCOVA comparisons of the non-FASD groups were significant only for weight (p<.004) when tested univariately and through stepdown analysis. Socioeconomic-adjusted trend plots were in the expected direction for nonverbal IQ, problem behaviors, attention, height, weight, OFC, vermilion, PFL, and total dysmorphology score.</p><p><strong>Conclusions: </strong>Even when meeting developmental norms, children with PAE exhibited trends of poorer growth and cognitive/behavioral traits than children without PAE. These findings support the notion that abstinence during pregnancy is best.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114327"},"PeriodicalIF":3.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367449","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}