Pub Date : 2025-02-10DOI: 10.1001/jamapediatrics.2024.6893
Suchitra K. Hourigan, Noel T. Mueller, Maria Gloria Dominguez-Bello
This Viewpoint discusses microbiome restoration by vaginal seeding in infants born by cesarean delivery and the potential of vaginal seeding to mitigate diseases associated with cesarean birth.
{"title":"Can Vaginal Seeding Improve Health Outcomes of Infants Born by Cesarean Delivery?","authors":"Suchitra K. Hourigan, Noel T. Mueller, Maria Gloria Dominguez-Bello","doi":"10.1001/jamapediatrics.2024.6893","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6893","url":null,"abstract":"This Viewpoint discusses microbiome restoration by vaginal seeding in infants born by cesarean delivery and the potential of vaginal seeding to mitigate diseases associated with cesarean birth.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"109 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1001/jamapediatrics.2024.6192
Susan Samuel, Zoya Punjwani, Daniella San Martin-Feeney, Brooke Allemang, Gregory M.T. Guilcher, Eddy Lang, Danièle Pacaud, Jorge Pinzon, Gail Andrew, Lonnie Zwaigenbaum, Curtis Perrott, John Andersen, Lorraine Hamiwka, Alberto Nettel-Aguirre, Scott Klarenbach, Kerry McBrien, Shannon D. Scott, Megan Patton, Sophie Samborn, Ken Pfister, Laurel Ryan, Gina Dimitropoulos, Andrew S. Mackie
ImportanceTransition to adult care is a challenging and complex process for youth and emerging adults with chronic health and/or mental health conditions. Patient navigation has been proposed to improve care during transition, but previous studies have used single disease cohorts with a nonrandomized design.ObjectiveTo compare the effectiveness of a patient navigator service to reduce emergency department (ED) use among adolescents and emerging adults with chronic health and/or mental health conditions undergoing transition to adult-oriented health care.Design, Setting, and ParticipantsThis was a pragmatic, parallel-group, nonblinded randomized clinical trial design. Patients were followed up for a minimum 12 months and maximum 24 months after enrollment. The setting was the Canadian province of Alberta, with a population of 4.3 million inhabitants, having 3 tertiary care pediatric hospitals serving the entire population with universal health coverage. Participants included youth aged 16 to 21 years, followed up within a diverse array of chronic care clinics, expected to be transferred to adult care within 12 months, residing in Alberta, Canada.InterventionsA 1:1 allocation to either access to a personalized navigator, an experienced social worker within the health services environment, or usual care, for up to 24 months after randomization.Main Outcomes and MeasuresAll-cause ED visit rate while under observation.ResultsA total of 335 participants were randomized over a period of 45 months, 164 (49.0%) to the intervention arm and 171 (51.0%) to usual care. After 1 patient withdrew, 334 participants (usual care: mean [SD] age, 17.8 [0.7] years; 99 female [57.9%]; intervention: mean [SD] age, 17.7 [0.6] years; 81 male [49.7%]) were included in the final data analysis. Among the participants, 131 (39.2%) resided in a rural location, and 126 (37.7%) had a self-reported mental health comorbidity during baseline assessment. We observed significant effect modification in the relationship between intervention and ED visits based on mental health comorbidity. Among those with a self-reported mental health condition, ED visit rates were lower in those with access to the navigator, but the association was not significant (adjusted incidence rate ratio [IRR] 0.75; 95% CI, 0.47-1.19). Among those with no mental health comorbidity, the corresponding adjusted IRR was 1.45 (95% CI, 0.95-2.20).Conclusions and RelevanceIn this randomized clinical trial, the navigator intervention was not associated with a significant reduction in ED visits among youth with chronic health conditions transitioning to adult care. The study did not accrue sufficient sample size to demonstrate a significant difference between groups should it exist.Trial RegistrationClinicalTrials.gov Identifier: NCT03342495
{"title":"Effectiveness of Patient Navigation During Transition to Adult Care","authors":"Susan Samuel, Zoya Punjwani, Daniella San Martin-Feeney, Brooke Allemang, Gregory M.T. Guilcher, Eddy Lang, Danièle Pacaud, Jorge Pinzon, Gail Andrew, Lonnie Zwaigenbaum, Curtis Perrott, John Andersen, Lorraine Hamiwka, Alberto Nettel-Aguirre, Scott Klarenbach, Kerry McBrien, Shannon D. Scott, Megan Patton, Sophie Samborn, Ken Pfister, Laurel Ryan, Gina Dimitropoulos, Andrew S. Mackie","doi":"10.1001/jamapediatrics.2024.6192","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6192","url":null,"abstract":"ImportanceTransition to adult care is a challenging and complex process for youth and emerging adults with chronic health and/or mental health conditions. Patient navigation has been proposed to improve care during transition, but previous studies have used single disease cohorts with a nonrandomized design.ObjectiveTo compare the effectiveness of a patient navigator service to reduce emergency department (ED) use among adolescents and emerging adults with chronic health and/or mental health conditions undergoing transition to adult-oriented health care.Design, Setting, and ParticipantsThis was a pragmatic, parallel-group, nonblinded randomized clinical trial design. Patients were followed up for a minimum 12 months and maximum 24 months after enrollment. The setting was the Canadian province of Alberta, with a population of 4.3 million inhabitants, having 3 tertiary care pediatric hospitals serving the entire population with universal health coverage. Participants included youth aged 16 to 21 years, followed up within a diverse array of chronic care clinics, expected to be transferred to adult care within 12 months, residing in Alberta, Canada.InterventionsA 1:1 allocation to either access to a personalized navigator, an experienced social worker within the health services environment, or usual care, for up to 24 months after randomization.Main Outcomes and MeasuresAll-cause ED visit rate while under observation.ResultsA total of 335 participants were randomized over a period of 45 months, 164 (49.0%) to the intervention arm and 171 (51.0%) to usual care. After 1 patient withdrew, 334 participants (usual care: mean [SD] age, 17.8 [0.7] years; 99 female [57.9%]; intervention: mean [SD] age, 17.7 [0.6] years; 81 male [49.7%]) were included in the final data analysis. Among the participants, 131 (39.2%) resided in a rural location, and 126 (37.7%) had a self-reported mental health comorbidity during baseline assessment. We observed significant effect modification in the relationship between intervention and ED visits based on mental health comorbidity. Among those with a self-reported mental health condition, ED visit rates were lower in those with access to the navigator, but the association was not significant (adjusted incidence rate ratio [IRR] 0.75; 95% CI, 0.47-1.19). Among those with no mental health comorbidity, the corresponding adjusted IRR was 1.45 (95% CI, 0.95-2.20).Conclusions and RelevanceIn this randomized clinical trial, the navigator intervention was not associated with a significant reduction in ED visits among youth with chronic health conditions transitioning to adult care. The study did not accrue sufficient sample size to demonstrate a significant difference between groups should it exist.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT03342495\">NCT03342495</jats:ext-link>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"12 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1001/jamapediatrics.2024.6774
Charles J. Billington, Arpana Rayannavar, Rebecca Tryon, Tory Kaye, Ashish Gupta, Troy C. Lund, Aida Lteif, Katherine L. Adriatico, Paul J. Orchard, Bradley S. Miller, Nishitha R. Pillai
This cohort study conducted among Minnesota children diagnosed with adrenoleukodystrophy through newborn screening examines correlation of C26:0 lysophosphatidylcholine (C26LPC) with clinical phenotype over 5 years and recommends adjusting early childhood surveillance regimens in children with lower C26LPC levels.
{"title":"Prognostication and Biomarker Potential of C26:0 Lysophosphatidylcholine in Adrenoleukodystrophy","authors":"Charles J. Billington, Arpana Rayannavar, Rebecca Tryon, Tory Kaye, Ashish Gupta, Troy C. Lund, Aida Lteif, Katherine L. Adriatico, Paul J. Orchard, Bradley S. Miller, Nishitha R. Pillai","doi":"10.1001/jamapediatrics.2024.6774","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6774","url":null,"abstract":"This cohort study conducted among Minnesota children diagnosed with adrenoleukodystrophy through newborn screening examines correlation of C26:0 lysophosphatidylcholine (C26LPC) with clinical phenotype over 5 years and recommends adjusting early childhood surveillance regimens in children with lower C26LPC levels.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"44 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1001/jamapediatrics.2024.6151
Evelyne Muggli, Harold Matthews, Michael Suttie, Jane Halliday, Anthony Penington, Elizabeth J. Elliott, Deanne Thompson, Alicia Spittle, Stephen Hearps, Peter J. Anderson, Peter Claes
ImportanceIn addition to confirmed prenatal alcohol exposure and severe neurodevelopmental deficits, three cardinal facial features are included in the diagnostic criteria for fetal alcohol spectrum disorder. It is not understood whether subtle facial characteristics occur in children without a diagnosis but who were exposed to a range of common pregnancy drinking patterns and, if so, whether these persist throughout childhood.ObjectiveTo determine whether subtle changes in facial shape with prenatal alcohol exposure found in 12-month-old children were evident at age 6 to 8 years using extended phenotyping methods and, if so, whether facial characteristics were similar to those seen in fetal alcohol spectrum disorder.Design, Setting, and ParticipantsIn a prospective cohort study in Melbourne, Victoria, Australia, commencing in July 2011 with follow-up through April 2021, pregnant women were recruited in the first trimester from low-risk, metropolitan, public maternity clinics over a period of 12 months. Three-dimensional craniofacial images from 549 children of European descent taken at age 12 months (n = 421 images) and 6 to 8 years (n = 363) were included. Data analysis was performed from May 2021 to October 2024.ExposuresPredominantly low to moderate prenatal alcohol exposure in the first trimester or throughout pregnancy compared with controls without prenatal alcohol exposure.Main Outcomes and MeasuresFollowing hierarchical facial segmentation, phenotype descriptors were computed. Hypothesis testing was performed for 63 facial modules to analyze different facial parts independently using principal component analysis and response-based imputed predictor (RIP) scores. Comparison was made with a clinical discovery sample of facial images of children with a confirmed diagnosis of partial or full fetal alcohol syndrome.ResultsA total of 549 children took part in the 3-dimensional craniofacial image analysis, of whom 235 (42.8%) contributed an image at both time points. Time 1 included 421 children, comprising 336 children (159 [47.3%] female) with any prenatal alcohol exposure and 85 control children (45 [52.9%] female); time 2 included 363 children, comprising 260 children with any prenatal alcohol exposure (125 [48.1%] female; mean [SD] age, 6.9 [0.7] years) and 103 control children (53 [51.5%] female; mean [SD] age, 6.8 [0.7] years). At both time points, there was consistent evidence for an association between prenatal alcohol exposure and the shape of the eyes (eg, module 15: RIP partial Spearman ρ, 0.19 [95% CI, 0.10-0.29; <jats:italic>P</jats:italic> &lt; .001] at 6-8 years) and nose (eg, module 5: RIP partial Spearman ρ, 0.19 [95% CI, 0.09-0.27; <jats:italic>P</jats:italic> &lt; .001] at 6-8 years), whether exposure occurred only in trimester 1 or throughout pregnancy. Facial variations observed differed from those in the clinical discovery sample.Conclusions and RelevanceLow to moderate prenatal alcohol exposure was associ
{"title":"Low to Moderate Prenatal Alcohol Exposure and Facial Shape of Children at Age 6 to 8 Years","authors":"Evelyne Muggli, Harold Matthews, Michael Suttie, Jane Halliday, Anthony Penington, Elizabeth J. Elliott, Deanne Thompson, Alicia Spittle, Stephen Hearps, Peter J. Anderson, Peter Claes","doi":"10.1001/jamapediatrics.2024.6151","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6151","url":null,"abstract":"ImportanceIn addition to confirmed prenatal alcohol exposure and severe neurodevelopmental deficits, three cardinal facial features are included in the diagnostic criteria for fetal alcohol spectrum disorder. It is not understood whether subtle facial characteristics occur in children without a diagnosis but who were exposed to a range of common pregnancy drinking patterns and, if so, whether these persist throughout childhood.ObjectiveTo determine whether subtle changes in facial shape with prenatal alcohol exposure found in 12-month-old children were evident at age 6 to 8 years using extended phenotyping methods and, if so, whether facial characteristics were similar to those seen in fetal alcohol spectrum disorder.Design, Setting, and ParticipantsIn a prospective cohort study in Melbourne, Victoria, Australia, commencing in July 2011 with follow-up through April 2021, pregnant women were recruited in the first trimester from low-risk, metropolitan, public maternity clinics over a period of 12 months. Three-dimensional craniofacial images from 549 children of European descent taken at age 12 months (n = 421 images) and 6 to 8 years (n = 363) were included. Data analysis was performed from May 2021 to October 2024.ExposuresPredominantly low to moderate prenatal alcohol exposure in the first trimester or throughout pregnancy compared with controls without prenatal alcohol exposure.Main Outcomes and MeasuresFollowing hierarchical facial segmentation, phenotype descriptors were computed. Hypothesis testing was performed for 63 facial modules to analyze different facial parts independently using principal component analysis and response-based imputed predictor (RIP) scores. Comparison was made with a clinical discovery sample of facial images of children with a confirmed diagnosis of partial or full fetal alcohol syndrome.ResultsA total of 549 children took part in the 3-dimensional craniofacial image analysis, of whom 235 (42.8%) contributed an image at both time points. Time 1 included 421 children, comprising 336 children (159 [47.3%] female) with any prenatal alcohol exposure and 85 control children (45 [52.9%] female); time 2 included 363 children, comprising 260 children with any prenatal alcohol exposure (125 [48.1%] female; mean [SD] age, 6.9 [0.7] years) and 103 control children (53 [51.5%] female; mean [SD] age, 6.8 [0.7] years). At both time points, there was consistent evidence for an association between prenatal alcohol exposure and the shape of the eyes (eg, module 15: RIP partial Spearman ρ, 0.19 [95% CI, 0.10-0.29; <jats:italic>P</jats:italic> &amp;lt; .001] at 6-8 years) and nose (eg, module 5: RIP partial Spearman ρ, 0.19 [95% CI, 0.09-0.27; <jats:italic>P</jats:italic> &amp;lt; .001] at 6-8 years), whether exposure occurred only in trimester 1 or throughout pregnancy. Facial variations observed differed from those in the clinical discovery sample.Conclusions and RelevanceLow to moderate prenatal alcohol exposure was associ","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"12 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1001/jamapediatrics.2024.6609
Pamela Emengo, Jonathan D Strope, Akanksha Sabapaty, Nolan R Martin, Talha Rafeeqi, Ashley Stevenson, Yousof Fawzy, Stephanie D Chao
{"title":"Victim-Shooter Relationships in Mass Shootings Involving Child Victims.","authors":"Pamela Emengo, Jonathan D Strope, Akanksha Sabapaty, Nolan R Martin, Talha Rafeeqi, Ashley Stevenson, Yousof Fawzy, Stephanie D Chao","doi":"10.1001/jamapediatrics.2024.6609","DOIUrl":"10.1001/jamapediatrics.2024.6609","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1001/jamapediatrics.2024.6771
Marc Engelen, Stephan Kemp
{"title":"Newborn Screening for Adrenoleukodystrophy.","authors":"Marc Engelen, Stephan Kemp","doi":"10.1001/jamapediatrics.2024.6771","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6771","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1001/jamapediatrics.2024.5920
Laura Olejnik, João Pedro Lima, Behnam Sadeghirad, Jason W. Busse, Ivan D. Florez, Samina Ali, James Bunker, Danny Jomaa, Adam Bleik, Mohamed Eltorki
ImportanceSeveral pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain.ObjectiveTo assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials.Data SourcesCochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023.Study SelectionTrials that enrolled children (aged &lt;18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included.Data Extraction and SynthesisPairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach.Main OutcomesThe primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events.ResultsA total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], −1.29; 95% CI, −1.89 to −0.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, −1.12; 95% CI, −2.09 to −0.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, −1.19; 95% CI, −1.83 to −0.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low/very low–certainty evidence.Conclusions and RelevanceCompared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.
{"title":"Pharmacologic Management of Acute Pain in Children","authors":"Laura Olejnik, João Pedro Lima, Behnam Sadeghirad, Jason W. Busse, Ivan D. Florez, Samina Ali, James Bunker, Danny Jomaa, Adam Bleik, Mohamed Eltorki","doi":"10.1001/jamapediatrics.2024.5920","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5920","url":null,"abstract":"ImportanceSeveral pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain.ObjectiveTo assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials.Data SourcesCochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023.Study SelectionTrials that enrolled children (aged &amp;lt;18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included.Data Extraction and SynthesisPairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach.Main OutcomesThe primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events.ResultsA total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], −1.29; 95% CI, −1.89 to −0.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, −1.12; 95% CI, −2.09 to −0.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, −1.19; 95% CI, −1.83 to −0.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low/very low–certainty evidence.Conclusions and RelevanceCompared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"166 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ImportanceHome-based interventions targeting socially disadvantaged families may help to improve maternal and child health. Only a few studies have investigated how different staffing models affect early home visiting program outcomes.ObjectiveTo assess the effects of 2 staffing models of an early childhood intervention on mother and child outcomes.Design, Setting, and ParticipantsThe baseline assessment of this randomized trial was conducted between November 2006 and December 2009 in 15 municipalities in Germany. The follow-up assessment at offspring age 7 years was carried out by interviewers masked to treatment conditions from April 2015 to December 2017. Data analysis was performed from March to August 2023. Pregnant women with no previous live birth, low-income, and at least 1 additional psychosocial risk factor were eligible. A total of 1157 women were referred to the study by gynecologists, psychosocial counseling services, or employment agencies; 755 were randomized to treatment conditions (2 intervention groups and 2 control groups); and 525 completed the follow-up.InterventionsBased on the Nurse-Family Partnership program, women assigned to the intervention groups received visits by either a midwife (midwife-only model) or by a team consisting of a social worker and a midwife (tandem model) until child age 2 years. Women assigned to control groups had access to the standard health and social services.Main Outcomes and MeasuresAverage treatment effects (ATEs) on the following primary outcomes were assessed using adjusted regression models with inverse probability weighting: developmental disorders, child behavioral problems, adverse, neglectful and abusive parenting, maternal mental health, and life satisfaction.ResultsThe mean (SD) age at follow-up was 29.6 (4.36) years for mothers and 7.55 (0.75) years for children; 272 (52.2%) of the children were female. Mothers in the tandem model reported fewer internalizing child behavioral problems compared to their control group (ATE, 2.98; 95% CI, −5.49 to −0.47; absolute reduction, 13.3 percentage points). Beneficial intervention effects were found in the midwife-only group on abusive parenting (ATE, −4.00; 95% CI, −6.82 to −1.18), parenting stress (ATE, −0.13; 95% CI, −0.20 to −0.06), and maternal mental health burden (ATE, −3.63; 95% CI, −6.03 to −1.22; absolute reduction, 6.6 percentage points in depressive symptoms), but not in the tandem group.Conclusions and RelevanceBoth staffing models produced positive intervention effects, with more effects seen in the midwife-only model. These insights can guide future early childhood intervention designs and may help improve health care for socially disadvantaged families.Trial RegistrationGerman Clinical Trials Register Identifier: DRKS00007554
{"title":"Maternal and Child Health Following 2 Home Visiting Interventions vs Control","authors":"Marie Lisanne Schepan, Malte Sandner, Gabriella Conti, Sören Kliem, Tilman Brand","doi":"10.1001/jamapediatrics.2024.5929","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5929","url":null,"abstract":"ImportanceHome-based interventions targeting socially disadvantaged families may help to improve maternal and child health. Only a few studies have investigated how different staffing models affect early home visiting program outcomes.ObjectiveTo assess the effects of 2 staffing models of an early childhood intervention on mother and child outcomes.Design, Setting, and ParticipantsThe baseline assessment of this randomized trial was conducted between November 2006 and December 2009 in 15 municipalities in Germany. The follow-up assessment at offspring age 7 years was carried out by interviewers masked to treatment conditions from April 2015 to December 2017. Data analysis was performed from March to August 2023. Pregnant women with no previous live birth, low-income, and at least 1 additional psychosocial risk factor were eligible. A total of 1157 women were referred to the study by gynecologists, psychosocial counseling services, or employment agencies; 755 were randomized to treatment conditions (2 intervention groups and 2 control groups); and 525 completed the follow-up.InterventionsBased on the Nurse-Family Partnership program, women assigned to the intervention groups received visits by either a midwife (midwife-only model) or by a team consisting of a social worker and a midwife (tandem model) until child age 2 years. Women assigned to control groups had access to the standard health and social services.Main Outcomes and MeasuresAverage treatment effects (ATEs) on the following primary outcomes were assessed using adjusted regression models with inverse probability weighting: developmental disorders, child behavioral problems, adverse, neglectful and abusive parenting, maternal mental health, and life satisfaction.ResultsThe mean (SD) age at follow-up was 29.6 (4.36) years for mothers and 7.55 (0.75) years for children; 272 (52.2%) of the children were female. Mothers in the tandem model reported fewer internalizing child behavioral problems compared to their control group (ATE, 2.98; 95% CI, −5.49 to −0.47; absolute reduction, 13.3 percentage points). Beneficial intervention effects were found in the midwife-only group on abusive parenting (ATE, −4.00; 95% CI, −6.82 to −1.18), parenting stress (ATE, −0.13; 95% CI, −0.20 to −0.06), and maternal mental health burden (ATE, −3.63; 95% CI, −6.03 to −1.22; absolute reduction, 6.6 percentage points in depressive symptoms), but not in the tandem group.Conclusions and RelevanceBoth staffing models produced positive intervention effects, with more effects seen in the midwife-only model. These insights can guide future early childhood intervention designs and may help improve health care for socially disadvantaged families.Trial RegistrationGerman Clinical Trials Register Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://drks.de/search/en/trial/DRKS00007554\">DRKS00007554</jats:ext-link>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"21 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1001/jamapediatrics.2024.6627
Dimitri A Christakis, Gina Marie Mathew, David A Reichenberger, Isaac R Rodriguez, Benny Ren, Lauren Hale
{"title":"Adolescent Smartphone Use During School Hours.","authors":"Dimitri A Christakis, Gina Marie Mathew, David A Reichenberger, Isaac R Rodriguez, Benny Ren, Lauren Hale","doi":"10.1001/jamapediatrics.2024.6627","DOIUrl":"10.1001/jamapediatrics.2024.6627","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1001/jamapediatrics.2024.6058
Caroline Melhado, Canaan Hancock, Haoyu Wang, Maya M. Eldin, Nicholas George, Jennifer A. Miller, Katherine E. Remick, Bhavin Patel, Brian K. Yorkgitis, Lisa Gray, Michael W. Dingeldein, Hilary A. Hewes, Katie W. Russell, Michael L. Nance, Aaron R. Jensen
ImportanceChildren initially treated in a timely fashion at trauma centers with high levels of pediatric readiness have been shown to have improved survival, but children historically have had geographically disparate access to pediatric trauma center care. Considerable effort has been invested in improving pediatric readiness nationally, including the implementation of new standards to improve emergency department pediatric readiness at all trauma centers.ObjectiveTo assess current access to US pediatric-ready trauma center care and to estimate potential improvement in access if all high-level trauma centers had optimal pediatric readiness.Design, Setting, and ParticipantsThis descriptive cross-sectional study collated trauma centers from national organizational lists, state government websites, and online searches. A geospatial analysis was performed of access by pediatric patients (aged ≤18 years) to trauma centers by ground or air ambulance within 60 minutes, stratified by trauma center type and pediatric readiness status. Population density was estimated using 2020 US census data. Weighted pediatric readiness scores (wPRS) were obtained from the 2021 National Pediatric Readiness Project assessment. The data analysis was performed between April 1 and June 30, 2023.ExposureAccess times to trauma centers.Main Outcome and MeasureThe main outcome of interest was access to a pediatric-ready trauma center, defined as a high-level pediatric trauma center (level I-II) or high-level adult trauma center (level I-III) with a wPRS of at least 93 (out of 100). Access times were calculated using previously validated methods and service network model analysis for each trauma center to census block group centroid.ResultsThe analysis included 148 pediatric and 1075 high-level adult trauma centers. A total of 273 adult centers (25%) were pediatric ready. Pediatric trauma center access within 60 minutes by ground or air ambulance was available for 65% of all 74 090 665 children; 73% of children had access to a pediatric-ready trauma center within 60 minutes, and 92% had access to any high-level trauma center within 60 minutes.ConclusionThese findings suggest that access to pediatric trauma center care is limited, even with air ambulance transport. Ensuring pediatric readiness at all high-level adult trauma centers may substantially improve access to early high-quality initial resuscitative trauma care for children.
{"title":"Pediatric Readiness and Trauma Center Access for Children","authors":"Caroline Melhado, Canaan Hancock, Haoyu Wang, Maya M. Eldin, Nicholas George, Jennifer A. Miller, Katherine E. Remick, Bhavin Patel, Brian K. Yorkgitis, Lisa Gray, Michael W. Dingeldein, Hilary A. Hewes, Katie W. Russell, Michael L. Nance, Aaron R. Jensen","doi":"10.1001/jamapediatrics.2024.6058","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6058","url":null,"abstract":"ImportanceChildren initially treated in a timely fashion at trauma centers with high levels of pediatric readiness have been shown to have improved survival, but children historically have had geographically disparate access to pediatric trauma center care. Considerable effort has been invested in improving pediatric readiness nationally, including the implementation of new standards to improve emergency department pediatric readiness at all trauma centers.ObjectiveTo assess current access to US pediatric-ready trauma center care and to estimate potential improvement in access if all high-level trauma centers had optimal pediatric readiness.Design, Setting, and ParticipantsThis descriptive cross-sectional study collated trauma centers from national organizational lists, state government websites, and online searches. A geospatial analysis was performed of access by pediatric patients (aged ≤18 years) to trauma centers by ground or air ambulance within 60 minutes, stratified by trauma center type and pediatric readiness status. Population density was estimated using 2020 US census data. Weighted pediatric readiness scores (wPRS) were obtained from the 2021 National Pediatric Readiness Project assessment. The data analysis was performed between April 1 and June 30, 2023.ExposureAccess times to trauma centers.Main Outcome and MeasureThe main outcome of interest was access to a pediatric-ready trauma center, defined as a high-level pediatric trauma center (level I-II) or high-level adult trauma center (level I-III) with a wPRS of at least 93 (out of 100). Access times were calculated using previously validated methods and service network model analysis for each trauma center to census block group centroid.ResultsThe analysis included 148 pediatric and 1075 high-level adult trauma centers. A total of 273 adult centers (25%) were pediatric ready. Pediatric trauma center access within 60 minutes by ground or air ambulance was available for 65% of all 74 090 665 children; 73% of children had access to a pediatric-ready trauma center within 60 minutes, and 92% had access to any high-level trauma center within 60 minutes.ConclusionThese findings suggest that access to pediatric trauma center care is limited, even with air ambulance transport. Ensuring pediatric readiness at all high-level adult trauma centers may substantially improve access to early high-quality initial resuscitative trauma care for children.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}