Pub Date : 2025-12-01DOI: 10.1001/jamapediatrics.2025.4935
João Guilherme G Tedde,Thiago Cerqueira-Silva,Orlagh Carroll,Laura C Rodrigues,Maria Gloria Teixeira,Nuria Sanchez Clemente,Mauricio L Barreto,Enny S Paixão
ImportanceEpilepsy is a major clinical concern in children with congenital Zika syndrome (CZS). However, whether in utero exposure to Zika virus (ZIKV) without development of CZS is associated with increased epilepsy risk compared with unexposed children remains unclear.ObjectiveTo compare the risk of epilepsy-related hospitalizations during the first 4 years of life among children exposed to ZIKV during pregnancy (with and without CZS) vs an unexposed group.Design, Setting, and ParticipantsThis was a population-based cohort study conducted in Brazil among live-born singleton children with 22 or more weeks' gestation born from January 2015 to November 2018. Data analysis was conducted from December 2024 to March 2025.ExposureIn utero exposure to ZIKV by maternal notification during pregnancy.Main Outcomes and MeasuresThe primary outcome was the time from birth to the first epilepsy-related hospitalization. Hazard ratios (HRs) and 95% CIs were estimated using a cause-specific Cox regression model, adjusting for maternal education level, maternal self-reported race and ethnicity, maternal age, year of child birth, and adequacy of the number of antenatal appointments. All-cause deaths were also considered as competing events.ResultsAmong 10 828 887 children (5 275 628 [48.7%] female; mean [SD] gestational age, 38.5 [2.0] weeks), 2780 (0.03%) had CZS and 8361 (0.08%) were exposed to ZIKV during pregnancy without developing CZS. After adjusting for confounders, CZS was associated with an increased risk of epilepsy-related hospital admission (adjusted HR [aHR], 34.22 [95% CI, 29.16-40.16]). Age-specific aHRs peaked at age 7 to 18 months (aHR [95% CI], 33.72 [24.70-46.04] for 0-6 months, 44.58 [35.89-55.36] for 7-18 months, and 20.62 [14.31-29.72] for 19-48 months). Children with CZS who were microcephalic, normocephalic, or macrocephalic showed similar associations with epilepsy-related admissions. Children exposed to ZIKV without CZS did not show increased risk compared with unexposed peers (aHR, 0.66 [95% CI, 0.34-1.27]).Conclusions and RelevanceIn this population-based cohort study, CZS was associated with elevated risk of epilepsy-related hospitalization in early childhood in Brazil. In contrast, children exposed to ZIKV during pregnancy without CZS did not appear to have higher risk of epilepsy-related admission compared with unexposed children.
{"title":"Prenatal Exposure to Zika Virus and Risk of Epilepsy-Related Hospitalization During Early Childhood.","authors":"João Guilherme G Tedde,Thiago Cerqueira-Silva,Orlagh Carroll,Laura C Rodrigues,Maria Gloria Teixeira,Nuria Sanchez Clemente,Mauricio L Barreto,Enny S Paixão","doi":"10.1001/jamapediatrics.2025.4935","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4935","url":null,"abstract":"ImportanceEpilepsy is a major clinical concern in children with congenital Zika syndrome (CZS). However, whether in utero exposure to Zika virus (ZIKV) without development of CZS is associated with increased epilepsy risk compared with unexposed children remains unclear.ObjectiveTo compare the risk of epilepsy-related hospitalizations during the first 4 years of life among children exposed to ZIKV during pregnancy (with and without CZS) vs an unexposed group.Design, Setting, and ParticipantsThis was a population-based cohort study conducted in Brazil among live-born singleton children with 22 or more weeks' gestation born from January 2015 to November 2018. Data analysis was conducted from December 2024 to March 2025.ExposureIn utero exposure to ZIKV by maternal notification during pregnancy.Main Outcomes and MeasuresThe primary outcome was the time from birth to the first epilepsy-related hospitalization. Hazard ratios (HRs) and 95% CIs were estimated using a cause-specific Cox regression model, adjusting for maternal education level, maternal self-reported race and ethnicity, maternal age, year of child birth, and adequacy of the number of antenatal appointments. All-cause deaths were also considered as competing events.ResultsAmong 10 828 887 children (5 275 628 [48.7%] female; mean [SD] gestational age, 38.5 [2.0] weeks), 2780 (0.03%) had CZS and 8361 (0.08%) were exposed to ZIKV during pregnancy without developing CZS. After adjusting for confounders, CZS was associated with an increased risk of epilepsy-related hospital admission (adjusted HR [aHR], 34.22 [95% CI, 29.16-40.16]). Age-specific aHRs peaked at age 7 to 18 months (aHR [95% CI], 33.72 [24.70-46.04] for 0-6 months, 44.58 [35.89-55.36] for 7-18 months, and 20.62 [14.31-29.72] for 19-48 months). Children with CZS who were microcephalic, normocephalic, or macrocephalic showed similar associations with epilepsy-related admissions. Children exposed to ZIKV without CZS did not show increased risk compared with unexposed peers (aHR, 0.66 [95% CI, 0.34-1.27]).Conclusions and RelevanceIn this population-based cohort study, CZS was associated with elevated risk of epilepsy-related hospitalization in early childhood in Brazil. In contrast, children exposed to ZIKV during pregnancy without CZS did not appear to have higher risk of epilepsy-related admission compared with unexposed children.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"55 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644862","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 : 2025-12-01DOI: 10.1001/jamapediatrics.2025.4752
Jonathan S Litt,Haresh M Kirpalani
{"title":"Stasis in Outcomes After Preterm Birth-As Good As It Gets?","authors":"Jonathan S Litt,Haresh M Kirpalani","doi":"10.1001/jamapediatrics.2025.4752","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4752","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"245 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644860","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 : 2025-12-01DOI: 10.1001/jamapediatrics.2025.4381
{"title":"Change to Open Access Status.","authors":"","doi":"10.1001/jamapediatrics.2025.4381","DOIUrl":"10.1001/jamapediatrics.2025.4381","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1367"},"PeriodicalIF":18.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232610","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 : 2025-12-01DOI: 10.1001/jamapediatrics.2025.4943
Charlotte H Tiplady,Jonathan P Mynard,Moya Vandeleur,Gyan Ainkaran,Sherly X Li,Rachel Climie,David P Burgner,Terence Dwyer,Catherine Quinlan,Danielle K Longmore
ImportanceThe prevalence of high blood pressure in children is increasing, with health consequences reaching into adulthood. Individual-level interventions may help address the burden of high blood pressure at a population level, but there is less evidence from pediatric settings.ObjectiveTo assess the effectiveness of school- or community-based lifestyle interventions to reduce high blood pressure in children (aged 3-18 years) and identify components that support effectiveness.Evidence ReviewOvid MEDLINE, Embase, and PubMed were searched for studies from June 2013 to March 2024. Randomized clinical trials and quasi-experimental studies were assessed using the following strict inclusion criteria: longer than 6-month intervention duration, participants aged 3 to 18 years, major aim to modify cardiometabolic risk, and measurement of blood pressure before and after the intervention. Interventions aimed at specific patient groups were excluded. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools. Blood pressure before and after the intervention was extracted, with the mean difference in blood pressure recorded. Data analysis was performed from June 2023 to July 2024.FindingsA total of 27 studies were included, of which 13 reported a beneficial effect on blood pressure; 24 studies targeted physical activity, 15 targeted nutrition, 16 targeted education, and 11 included family involvement. Of 14 multicomponent studies, 9 reported a beneficial effect on blood pressure.Conclusions and RelevanceIn this systematic review, results indicate that lifestyle interventions can have a beneficial effect on blood pressure in the pediatric population, with multicomponent designs targeting both physical activity and nutrition showing the most promise. Future research should aim to further clarify intervention design and physical activity dosage, feasibility, and scalability, along with the long-term success of interventions that promote healthy blood pressure in children.
{"title":"Lifestyle Interventions Addressing Blood Pressure in Children: A Systematic Review.","authors":"Charlotte H Tiplady,Jonathan P Mynard,Moya Vandeleur,Gyan Ainkaran,Sherly X Li,Rachel Climie,David P Burgner,Terence Dwyer,Catherine Quinlan,Danielle K Longmore","doi":"10.1001/jamapediatrics.2025.4943","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4943","url":null,"abstract":"ImportanceThe prevalence of high blood pressure in children is increasing, with health consequences reaching into adulthood. Individual-level interventions may help address the burden of high blood pressure at a population level, but there is less evidence from pediatric settings.ObjectiveTo assess the effectiveness of school- or community-based lifestyle interventions to reduce high blood pressure in children (aged 3-18 years) and identify components that support effectiveness.Evidence ReviewOvid MEDLINE, Embase, and PubMed were searched for studies from June 2013 to March 2024. Randomized clinical trials and quasi-experimental studies were assessed using the following strict inclusion criteria: longer than 6-month intervention duration, participants aged 3 to 18 years, major aim to modify cardiometabolic risk, and measurement of blood pressure before and after the intervention. Interventions aimed at specific patient groups were excluded. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools. Blood pressure before and after the intervention was extracted, with the mean difference in blood pressure recorded. Data analysis was performed from June 2023 to July 2024.FindingsA total of 27 studies were included, of which 13 reported a beneficial effect on blood pressure; 24 studies targeted physical activity, 15 targeted nutrition, 16 targeted education, and 11 included family involvement. Of 14 multicomponent studies, 9 reported a beneficial effect on blood pressure.Conclusions and RelevanceIn this systematic review, results indicate that lifestyle interventions can have a beneficial effect on blood pressure in the pediatric population, with multicomponent designs targeting both physical activity and nutrition showing the most promise. Future research should aim to further clarify intervention design and physical activity dosage, feasibility, and scalability, along with the long-term success of interventions that promote healthy blood pressure in children.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"110 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644859","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 : 2025-11-24DOI: 10.1001/jamapediatrics.2025.4498
Meghan Zimmer,Jiada Zhan,Cristina Gago,Teresa T Fung,Cindy W Leung,Erica L Kenney
{"title":"Prepandemic National Estimates of Toddler and Child Diet Quality by WIC Participation Status.","authors":"Meghan Zimmer,Jiada Zhan,Cristina Gago,Teresa T Fung,Cindy W Leung,Erica L Kenney","doi":"10.1001/jamapediatrics.2025.4498","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4498","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"33 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582981","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 : 2025-11-24DOI: 10.1001/jamapediatrics.2025.4332
Maria Isabel Angulo,Geisel R Collazo,Lindsay A Thompson
{"title":"What Parents and Teens Need to Know About Testicular Pain.","authors":"Maria Isabel Angulo,Geisel R Collazo,Lindsay A Thompson","doi":"10.1001/jamapediatrics.2025.4332","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4332","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"100 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582982","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 : 2025-11-24DOI: 10.1001/jamapediatrics.2025.4786
Ludvig Daae Bjørndal,Elizabeth C Corfield,Laurie J Hannigan,Ziada Ayorech,Cynthia M Bulik,Hunna J Watson,Lisa Dinkler,Samuel J R A Chawner,Stefan Johansson,Ole A Andreassen,Helga Ask,Alexandra Havdahl
ImportanceA narrow range of food consumption and/or restricted eating is a core feature of avoidant/restrictive food intake (ARFI) disorder. However, there is limited knowledge of developmental characteristics of children with ARFI and its etiological influences, which constrains research, prevention, and intervention efforts.ObjectiveTo estimate the prevalence of ARFI phenotypes in a population-based sample, examine developmental characteristics across childhood, and investigate the genetic architecture of ARFI using genome-wide association analyses.Design, Setting, and ParticipantsThis preregistered study used data from children born from 1999 to 2009 in the population-based Norwegian Mother, Father, and Child Cohort Study (MoBa), with mother-reported data on ARFI symptoms at 3 and 8 years and linkage with diagnostic data from population health registries. Data were analyzed from March 2024 to May 2025.ExposuresMultiple items were used to identify children with broad ARFI. These children were subclassified into 3 groups based on symptom persistence: ARFI-broad transient (only at age 3 years), emergent (only at age 8 years), and persistent (ages 3 and 8 years). Children in these groups with 1 or more indicators of clinical significance (eg, nutritional deficiency) were further classified into ARFI-clinical subgroups.Main Outcomes and MeasuresARFI groups were compared across developmental characteristics from 6 months to 14 years. Genome-wide methods were used to examine single-nucleotide variant (SNV) heritability (SNV-h2), conduct genetic association analyses, and quantify genetic correlations with other phenotypes.ResultsOf 35 751 children with available ARFI assessments at 3 and 8 years (18 236 male [51%]), the prevalence of ARFI-broad persistent, transient, and emergent was 2129 (6.0%), 6338 (17.7%), and 3001 (8.4%), respectively. The prevalence of ARFI-clinical persistent, transient, and emergent was 624 (1.8%), 1157 (3.2%), and 484 (1.4%), respectively (2265 [6.3%] overall). Children with ARFI-broad persistent exhibited more developmental difficulties compared with children with no ARFI. SNV-h2 ranged from 8% to 16%. Two independent genome-wide significant loci were identified. For ARFI-clinical, a significant association was identified with ADCY3 (z = 5.42; P = 3.03 × 10-8). Small to moderate genetic correlations were observed for ARFI-broad, ARFI-clinical and mental health, cognitive/educational, anthropometric, food-associated, and gastrointestinal disorder phenotypes.Conclusions and RelevanceThis cohort study found that the prevalence of ARFI in the general pediatric population was substantial, and affected children had an associated elevated risk of developmental difficulties across multiple domains. Findings suggest a need for broad support interventions and advance understanding of the genetic underpinnings of ARFI.
{"title":"Prevalence, Characteristics, and Genetic Architecture of Avoidant/Restrictive Food Intake Phenotypes.","authors":"Ludvig Daae Bjørndal,Elizabeth C Corfield,Laurie J Hannigan,Ziada Ayorech,Cynthia M Bulik,Hunna J Watson,Lisa Dinkler,Samuel J R A Chawner,Stefan Johansson,Ole A Andreassen,Helga Ask,Alexandra Havdahl","doi":"10.1001/jamapediatrics.2025.4786","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4786","url":null,"abstract":"ImportanceA narrow range of food consumption and/or restricted eating is a core feature of avoidant/restrictive food intake (ARFI) disorder. However, there is limited knowledge of developmental characteristics of children with ARFI and its etiological influences, which constrains research, prevention, and intervention efforts.ObjectiveTo estimate the prevalence of ARFI phenotypes in a population-based sample, examine developmental characteristics across childhood, and investigate the genetic architecture of ARFI using genome-wide association analyses.Design, Setting, and ParticipantsThis preregistered study used data from children born from 1999 to 2009 in the population-based Norwegian Mother, Father, and Child Cohort Study (MoBa), with mother-reported data on ARFI symptoms at 3 and 8 years and linkage with diagnostic data from population health registries. Data were analyzed from March 2024 to May 2025.ExposuresMultiple items were used to identify children with broad ARFI. These children were subclassified into 3 groups based on symptom persistence: ARFI-broad transient (only at age 3 years), emergent (only at age 8 years), and persistent (ages 3 and 8 years). Children in these groups with 1 or more indicators of clinical significance (eg, nutritional deficiency) were further classified into ARFI-clinical subgroups.Main Outcomes and MeasuresARFI groups were compared across developmental characteristics from 6 months to 14 years. Genome-wide methods were used to examine single-nucleotide variant (SNV) heritability (SNV-h2), conduct genetic association analyses, and quantify genetic correlations with other phenotypes.ResultsOf 35 751 children with available ARFI assessments at 3 and 8 years (18 236 male [51%]), the prevalence of ARFI-broad persistent, transient, and emergent was 2129 (6.0%), 6338 (17.7%), and 3001 (8.4%), respectively. The prevalence of ARFI-clinical persistent, transient, and emergent was 624 (1.8%), 1157 (3.2%), and 484 (1.4%), respectively (2265 [6.3%] overall). Children with ARFI-broad persistent exhibited more developmental difficulties compared with children with no ARFI. SNV-h2 ranged from 8% to 16%. Two independent genome-wide significant loci were identified. For ARFI-clinical, a significant association was identified with ADCY3 (z = 5.42; P = 3.03 × 10-8). Small to moderate genetic correlations were observed for ARFI-broad, ARFI-clinical and mental health, cognitive/educational, anthropometric, food-associated, and gastrointestinal disorder phenotypes.Conclusions and RelevanceThis cohort study found that the prevalence of ARFI in the general pediatric population was substantial, and affected children had an associated elevated risk of developmental difficulties across multiple domains. Findings suggest a need for broad support interventions and advance understanding of the genetic underpinnings of ARFI.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"46 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582983","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：