JAMA Pediatrics最新文献

Importance: Understanding the within-person association between daily screen use and sleep can help clarify whether this association reflects potentially causal effects or confounding factors.

Objective: To synthesize evidence on the within-person association between daily screen use and sleep among youth and to examine whether this association varies by screen type, sleep assessment method, or timing of screen use.

Data sources: Ovid MEDLINE, PsycINFO, SPORTDiscus, and Scopus were searched from inception to August 22, 2025, with forward and backward snowball searching. Data were analyzed in October 2025.

Study selection: Studies reporting on children, adolescents, and young adults aged 3 to 25 years that assessed sleep, measured screen time, and examined daily within-person associations between screen time and sleep were analyzed.

Data extraction and synthesis: Random-effects meta-analysis with cluster-robust variance estimation estimated pooled within-person correlations. Subgroup analyses examined moderating effects of screen type, assessment method, and timing.

Main outcomes and measures: The primary outcome was within-person correlations between screen time and sleep outcomes, including total sleep time, sleep onset, sleep onset latency, sleep efficiency, wake after sleep onset, and subjective sleep quality.

Results: A total of 25 studies reporting on 4562 participants were included. A small significant positive within-person correlation was found between screen time and sleep onset (r = 0.079; 95% CI, 0.010-0.149; P = .03), indicating later bedtimes on days with increased screen use. No significant associations were observed for total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, or subjective sleep quality. Moderator analyses revealed that the association between screen time and subjective sleep quality significantly differed by timing, with screen time after bedtime showing stronger negative correlation (r = -0.092) vs daily (r = -0.026) or evening (r = -0.005) assessments (P = .007). No other significant moderator effects were observed.

Conclusions and relevance: Per the results of this systematic review and meta-analysis, daily screen time has a small but significant within-person correlation with later sleep onset; however, short-term daily fluctuations in screen time appear to have minimal impact on sleep duration, efficiency, or quality. Screen time may delay bedtime but is not inherently detrimental to other aspects of sleep health in youth, contrasting with between-person studies showing stronger adverse associations.

Importance: Timely identification of acute brain injury (ABI) in children receiving extracorporeal membrane oxygenation (ECMO) support is critical for early neuroprotective interventions.

Objectives: To determine if elevations in plasma glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau levels in children receiving ECMO precede new ABI confirmed by neuroimaging, and if they are associated with mortality and functional outcomes.

Design, setting, and participants: This was a prospective observational cohort study conducted from 2019 to 2023, with 18-month follow-up completed in 2025. Children aged 2 days to younger than 18 years at ECMO cannulation were recruited from 11 US children's hospitals. Study data were analyzed from May to August 2025.

Exposures: GFAP, NfL, and tau measured in plasma samples collected serially during the ECMO course.

Main outcomes and measures: Unfavorable short-term outcome was a composite of in-hospital mortality or discharge Pediatric Cerebral Performance Category score of 3 or greater with decline of at least 1 point from baseline. Unfavorable long-term outcome was a composite of mortality or Vineland Adaptive Behavior Scales, third edition, composite score less than 85 at 18 months after ECMO.

Results: This study included 219 participants (224 ECMO courses; 1089 serial blood samples). Median age was 11 months (IQR, 30 days-9 years), and 121 (54%) were male. Among 60 ECMO courses with new ABI during the ECMO course, GFAP and NfL levels increased significantly, by 6.4% (95% CI, 1.4%-11.6%) and 16.1% (95% CI, 10.5%-22.0%), respectively, for each 24 hours preceding neuroimaging diagnosis of new ABI. Geometric means for GFAP, NfL, and tau were all significantly higher in those with unfavorable vs favorable outcome at hospital discharge for both the first sample receiving ECMO and peak levels during ECMO support. A 2-fold increase in GFAP and NfL levels from first sample receiving ECMO was significantly associated with unfavorable outcome after adjusting for baseline GFAP and NfL levels, age, and ECMO indication (GFAP adjusted hazard ratio [aHR], 1.48; 95% CI, 1.22-1.79; NfL aHR, 1.43; 95% CI, 1.14-1.79). Similar models for tau showed no significant association with outcomes.

Conclusions and relevance: Results suggest that GFAP and NfL may be promising candidates for real-time neurologic monitoring in children receiving ECMO and may aid in diagnosis, association with outcomes, and potentially guiding neuroprotective strategies.