Pub Date : 2026-02-02DOI: 10.1001/jamapediatrics.2025.5967
Sophie Driker, Sitarah Mathias, Alastair Fung, Suci Ardini Widyaningsih, Naomi Schmeck, Jana Adnan, Yumin Kim, Anum S. Hussaini, Tessa Kehoe, Krysten North, Amber Hoey, Yasir Shafiq, Carrie G. Wade, Rishi P. Mediratta, Chris A. Rees, Anne CC Lee
Importance Early and accurate identification of clinical warning signs in young infants may help avert sepsis morbidity and mortality in resource-limited settings. Objective To systematically review evidence on the association and accuracy of clinical signs to diagnose sepsis or predict mortality in young infants aged 0 to 59 days to inform management in settings with limited laboratory diagnostics. Data Sources MEDLINE, Embase, CINAHL, Global Index Medicus, and Cochrane CENTRAL Register were searched from inception through May 2023, with updated searches on September 5, 2024. An umbrella search of systematic reviews was conducted in January 2024. Study Selection Included studies reported data on 24 infant clinical signs informed by current World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and hospital-based algorithms for the care of sick young infants reporting odds ratios (OR), risk ratios, or sensitivity and specificity. Data Extraction and Synthesis Data were extracted independently by 2 reviewers. Quality assessment used the Newcastle-Ottawa, Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), and Quality Assessment of Prognostic Accuracy Studies (QUAPAS) scales. OR data were pooled using random-effects models. Data analysis was performed from July to September 2025. Main Outcomes and Measures OR of all-cause mortality, culture-confirmed sepsis, or clinical sepsis (with access to laboratory investigations). Results Of 7641 studies, 52 studies with 140 885 participants were included. A total of 16 clinical signs were significantly associated with mortality, 11 with culture-confirmed sepsis, and 13 with clinical sepsis. For mortality, the 5 strongest associations were weak, abnormal, or absent cry (OR, 20.48; 95% CI, 6.59-63.67); not able to feed at all (OR, 18.32; 95% CI, 6.00-55.97); not feeding well (OR, 13.39; 95% CI, 6.97-25.72); drowsiness or unconsciousness (OR, 12.46; 95% CI, 6.06-25.62); and prolonged capillary refill (OR, 12.06; 95% CI, 2.77-52.53). The top 5 signs associated with culture-confirmed sepsis were not feeding well (OR, 4.52; 95% CI, 1.10-18.59); prolonged capillary refill (OR, 3.59; 95% CI, 2.05-6.28); lethargy (OR, 3.44; 95% CI, 1.89-6.26); drowsiness or unconsciousness (OR, 3.07; 95% CI, 2.01-4.68); and feeding intolerance (OR, 2.95; 95% CI, 1.67-5.21). Conclusions and Relevance All current WHO IMCI clinical signs were significantly associated with mortality or culture-confirmed sepsis. Several signs not in IMCI were identified that may improve identification of life-threatening illness in young infants in resource-limited settings where clinical sign algorithms are the primary diagnostic tool.
{"title":"Clinical Signs Associated With Mortality and Sepsis in Young Infants","authors":"Sophie Driker, Sitarah Mathias, Alastair Fung, Suci Ardini Widyaningsih, Naomi Schmeck, Jana Adnan, Yumin Kim, Anum S. Hussaini, Tessa Kehoe, Krysten North, Amber Hoey, Yasir Shafiq, Carrie G. Wade, Rishi P. Mediratta, Chris A. Rees, Anne CC Lee","doi":"10.1001/jamapediatrics.2025.5967","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5967","url":null,"abstract":"Importance Early and accurate identification of clinical warning signs in young infants may help avert sepsis morbidity and mortality in resource-limited settings. Objective To systematically review evidence on the association and accuracy of clinical signs to diagnose sepsis or predict mortality in young infants aged 0 to 59 days to inform management in settings with limited laboratory diagnostics. Data Sources MEDLINE, Embase, CINAHL, Global Index Medicus, and Cochrane CENTRAL Register were searched from inception through May 2023, with updated searches on September 5, 2024. An umbrella search of systematic reviews was conducted in January 2024. Study Selection Included studies reported data on 24 infant clinical signs informed by current World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and hospital-based algorithms for the care of sick young infants reporting odds ratios (OR), risk ratios, or sensitivity and specificity. Data Extraction and Synthesis Data were extracted independently by 2 reviewers. Quality assessment used the Newcastle-Ottawa, Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), and Quality Assessment of Prognostic Accuracy Studies (QUAPAS) scales. OR data were pooled using random-effects models. Data analysis was performed from July to September 2025. Main Outcomes and Measures OR of all-cause mortality, culture-confirmed sepsis, or clinical sepsis (with access to laboratory investigations). Results Of 7641 studies, 52 studies with 140 885 participants were included. A total of 16 clinical signs were significantly associated with mortality, 11 with culture-confirmed sepsis, and 13 with clinical sepsis. For mortality, the 5 strongest associations were weak, abnormal, or absent cry (OR, 20.48; 95% CI, 6.59-63.67); not able to feed at all (OR, 18.32; 95% CI, 6.00-55.97); not feeding well (OR, 13.39; 95% CI, 6.97-25.72); drowsiness or unconsciousness (OR, 12.46; 95% CI, 6.06-25.62); and prolonged capillary refill (OR, 12.06; 95% CI, 2.77-52.53). The top 5 signs associated with culture-confirmed sepsis were not feeding well (OR, 4.52; 95% CI, 1.10-18.59); prolonged capillary refill (OR, 3.59; 95% CI, 2.05-6.28); lethargy (OR, 3.44; 95% CI, 1.89-6.26); drowsiness or unconsciousness (OR, 3.07; 95% CI, 2.01-4.68); and feeding intolerance (OR, 2.95; 95% CI, 1.67-5.21). Conclusions and Relevance All current WHO IMCI clinical signs were significantly associated with mortality or culture-confirmed sepsis. Several signs not in IMCI were identified that may improve identification of life-threatening illness in young infants in resource-limited settings where clinical sign algorithms are the primary diagnostic tool.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"275 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101364","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 : 2026-02-02DOI: 10.1001/jamapediatrics.2025.5934
Elenir B C Avritscher
{"title":"Further Considerations in Pediatric Appendicitis.","authors":"Elenir B C Avritscher","doi":"10.1001/jamapediatrics.2025.5934","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5934","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105454","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 : 2026-02-02DOI: 10.1001/jamapediatrics.2025.5949
Maya Koven, Gillian Shoychet, Heather Prime
This Viewpoint describes the effectiveness of integrating comprehensive family systems assessments into child mental health care to identify and address barriers to diagnosis and treatment.
本观点描述了将综合家庭系统评估纳入儿童精神卫生保健以识别和解决诊断和治疗障碍的有效性。
{"title":"Why Family Assessments Are Key to Child Mental Health","authors":"Maya Koven, Gillian Shoychet, Heather Prime","doi":"10.1001/jamapediatrics.2025.5949","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5949","url":null,"abstract":"This Viewpoint describes the effectiveness of integrating comprehensive family systems assessments into child mental health care to identify and address barriers to diagnosis and treatment.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101365","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 : 2026-02-01DOI: 10.1001/jamapediatrics.2025.5421
{"title":"Errors in Figures and Tables.","authors":"","doi":"10.1001/jamapediatrics.2025.5421","DOIUrl":"10.1001/jamapediatrics.2025.5421","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"221"},"PeriodicalIF":18.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804470","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 : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5816
Robert C Whitaker,Tracy Dearth-Wesley,Allison N Herman,Micah C Jordan
ImportanceLoneliness and perceived social isolation, with their negative health impacts, are increasing. It is not known whether adolescents with greater levels of family connection experience greater social connection as adults.ObjectiveTo determine the association between adolescents' sense of connection with their families and their overall social connection in adulthood.Design, Setting, and ParticipantsThis cohort study of a nationally representative US sample used data from 5 survey waves of The National Longitudinal Study of Adolescent to Adult Health: I (1994-1995), II (1996), III (2001-2002), IV (2008-2009), and V (2016-2018). Wave I involved 20 745 adolescents (grades 7-12), and 7293 participated in all 4 subsequent waves. Data were analyzed from April through November 2025.ExposureQuartiles of adolescent family connection were created using responses to 5 items asked in wave II, and covariates, including indicators of socioeconomic status, were assessed at wave I.Main Outcomes and MeasuresAdult social connection was assessed at waves IV and V with a score (0-6) created by summing 6 binary measures (no = 0, yes = 1) across 3 dimensions of social connection: structure ([1] participated in weekly activities with relatives/friends or neighbors, [2] had >2 close friends), function ([3] high perceived social support, [4] never felt isolated), and quality ([5] very close with either parent figure, [6] high relationship satisfaction with partner).ResultsThe analytic sample contained 7018 of the 7293 respondents to all 5 waves. The mean (SD) ages at waves II, IV, and V were 16.3 (1.8), 28.2 (1.8), and 37.3 (1.9) years, respectively, and 4097 respondents (49.7%) were female. The covariate-adjusted prevalence of high social connection in adulthood (score ≥4) increased across increasing quartiles of family connection in adolescence: 16.1% (95% CI, 13.4%-18.9%) for low, 22.0% (95% CI, 18.9%-25.1%) for medium-low, 28.6% (95% CI, 25.1%-32.1%) for medium-high, and 39.5% (95% CI, 36.2%-42.8%) for high family connection. The prevalence of high social connection in adulthood was 23.4 (95% CI, 19.2-27.6) percentage points greater in those in the highest quartile of adolescent family connection than those in the lowest quartile.Conclusions and RelevanceIn this cohort study, among US adolescents, those reporting higher family connection had higher levels of social connection as adults up to 2 decades later. These findings suggest that increasing family connection during adolescence may help reduce the burden of adult social disconnection.
{"title":"Family Connection in Adolescence and Social Connection in Adulthood.","authors":"Robert C Whitaker,Tracy Dearth-Wesley,Allison N Herman,Micah C Jordan","doi":"10.1001/jamapediatrics.2025.5816","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5816","url":null,"abstract":"ImportanceLoneliness and perceived social isolation, with their negative health impacts, are increasing. It is not known whether adolescents with greater levels of family connection experience greater social connection as adults.ObjectiveTo determine the association between adolescents' sense of connection with their families and their overall social connection in adulthood.Design, Setting, and ParticipantsThis cohort study of a nationally representative US sample used data from 5 survey waves of The National Longitudinal Study of Adolescent to Adult Health: I (1994-1995), II (1996), III (2001-2002), IV (2008-2009), and V (2016-2018). Wave I involved 20 745 adolescents (grades 7-12), and 7293 participated in all 4 subsequent waves. Data were analyzed from April through November 2025.ExposureQuartiles of adolescent family connection were created using responses to 5 items asked in wave II, and covariates, including indicators of socioeconomic status, were assessed at wave I.Main Outcomes and MeasuresAdult social connection was assessed at waves IV and V with a score (0-6) created by summing 6 binary measures (no = 0, yes = 1) across 3 dimensions of social connection: structure ([1] participated in weekly activities with relatives/friends or neighbors, [2] had >2 close friends), function ([3] high perceived social support, [4] never felt isolated), and quality ([5] very close with either parent figure, [6] high relationship satisfaction with partner).ResultsThe analytic sample contained 7018 of the 7293 respondents to all 5 waves. The mean (SD) ages at waves II, IV, and V were 16.3 (1.8), 28.2 (1.8), and 37.3 (1.9) years, respectively, and 4097 respondents (49.7%) were female. The covariate-adjusted prevalence of high social connection in adulthood (score ≥4) increased across increasing quartiles of family connection in adolescence: 16.1% (95% CI, 13.4%-18.9%) for low, 22.0% (95% CI, 18.9%-25.1%) for medium-low, 28.6% (95% CI, 25.1%-32.1%) for medium-high, and 39.5% (95% CI, 36.2%-42.8%) for high family connection. The prevalence of high social connection in adulthood was 23.4 (95% CI, 19.2-27.6) percentage points greater in those in the highest quartile of adolescent family connection than those in the lowest quartile.Conclusions and RelevanceIn this cohort study, among US adolescents, those reporting higher family connection had higher levels of social connection as adults up to 2 decades later. These findings suggest that increasing family connection during adolescence may help reduce the burden of adult social disconnection.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"30 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044670","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 : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5964
Lauren E Wisk, Kathryn M Leifheit
{"title":"Important Role of Social Policies to Prevent Child Maltreatment.","authors":"Lauren E Wisk, Kathryn M Leifheit","doi":"10.1001/jamapediatrics.2025.5964","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5964","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052120","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 : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5714
Darja Beinenson, Jacqueline Joyce, Gabrielle Becka, Marcus Graham, Claudia Morris, John N. Constantino, Justine W. Welsh
This quality improvement study examines the implementation of a substance use screening tool among youth presenting with behavioral and mental health crises in pediatric emergency departments.
本质量改进研究考察了在儿科急诊科表现为行为和精神健康危机的青少年中物质使用筛查工具的实施情况。
{"title":"Substance Use Screening in Pediatric Emergency Departments for Youth in Behavioral Crisis","authors":"Darja Beinenson, Jacqueline Joyce, Gabrielle Becka, Marcus Graham, Claudia Morris, John N. Constantino, Justine W. Welsh","doi":"10.1001/jamapediatrics.2025.5714","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5714","url":null,"abstract":"This quality improvement study examines the implementation of a substance use screening tool among youth presenting with behavioral and mental health crises in pediatric emergency departments.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146048221","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}
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