JAMA Pediatrics最新文献

{"title":"NICHD Magnetic Resonance Brain Imaging Score in Term Infants With Hypoxic-Ischemic Encephalopathy: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Seetha Shankaran, Abbot R Laptook, Carolina Guimaraes, Johnathan Murnick, Scott A McDonald, Abhik Das, Carolyn M Petrie Huitema, Athina Pappas, Rosemary D Higgins, Susan R Hintz, Kristin M Zaterka-Baxter, Krisa P Van Meurs, Gregory M Sokol, Lina F Chalak, Tarah T Colaizy, Uday Devaskar, Jon E Tyson, Anne Marie Reynolds, Sara B DeMauro, Pablo J Sánchez, Matthew M Laughon, Waldemar A Carlo, Kristi Watterberg, Karen M Puopolo, Anna Maria Hibbs, Shannon E G Hamrick, C Michael Cotten, John Barks, Brenda B Poindexter, William E Truog, Carl T D'Angio","doi":"10.1001/jamapediatrics.2024.6209","DOIUrl":"10.1001/jamapediatrics.2024.6209","url":null,"abstract":"<p><strong>Importance: </strong>The neonatal brain injury score on magnetic resonance imaging following moderate or severe hypoxic-ischemic encephalopathy developed by the National Institute of Child Health and Human Development Neonatal Research Network has been revised to separate watershed and basal ganglia or thalamic injury and their associated outcomes.</p><p><strong>Objective: </strong>To evaluate the association of the injury score with outcomes of death or moderate or severe disability among all infants, and with neurodevelopment among survivors in a trial of deeper and longer cooling.</p><p><strong>Design, setting, and participants: </strong>In this secondary analysis of a multicenter randomized clinical trial, brain imaging was obtained from infants between October 2010 and November 2013. Infants were followed up to 18 months of age, with follow-up completed in January 2016. Data analysis was performed from August 2021 to September 2024.</p><p><strong>Interventions: </strong>Infants were assigned to 4 hypothermia groups based on depth and duration of cooling, stratified by center and level of encephalopathy in a 2 × 2 factorial design to cooling at 33.5 °C or 32.0 °C and to 72 or 120 hours. A 10-level brain injury score was examined.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was death or moderate or severe disability measured by the Bayley Scales of Infant and Toddler Development III, the Gross Motor Function Classification System level, vision, and hearing.</p><p><strong>Results: </strong>This study included 298 infants who had magnetic resonance imaging (MRI) and primary outcome data among 364 infants of the initial cohort (mean [SD] age at MRI, 9.18 [4.49] days). Death or moderate or severe disability occurred in 72 of 298 infants (24%), and disability occurred in 52 of 278 surviving infants (19%). Death or disability occurred in 12 of 28 infants (43%) with any or predominant watershed injury and in 17 of 46 (37%) of those with any or predominant basal ganglia or thalamic injury. Among the 32 infants with hemispheric devastation, 30 (94%) had death or disability, and 17 (89%) survived with moderate or severe disability. Injury scores of increasing severity were associated with death or disability among all infants (odds ratio, 13.66 [95% CI, 7.47-24.95]; area under the curve, 0.84 [95% CI, 0.78-0.90]) and with disability among surviving infants (odds ratio, 10.52 [95% CI, 5.46-20.28]; area under the curve, 0.80 [95% CI, 0.73-0.88]). There were no differences in the injury score between infants undergoing usual care cooling and those cooled to a greater depth or longer duration.</p><p><strong>Conclusions: </strong>Among infants with hypoxic-ischemic encephalopathy, outcomes were similar between infants with watershed and basal ganglia injury. Higher imaging scores were associated with risk of death or disability among all infants and with neurodevelopmental disability among surviving infants.</p><p><stron","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440819","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}

{"title":"Maternal Downward Neighborhood Income Mobility and Ensuing Severe Neonatal Morbidity","authors":"Jennifer A. Jairam, Eyal Cohen, Christina Diong, Howard Berger, Hilary K. Brown, Jun Guan, Joel G. Ray","doi":"10.1001/jamapediatrics.2024.6667","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6667","url":null,"abstract":"This population-based cohort study examines changes in mothers’ neighborhood income between 2 consecutive births and associated morbidity/mortality outcomes in their newborns.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"49 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427382","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}

{"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}

{"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}

{"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}

{"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; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001] at 6-8 years) and nose (eg, module 5: RIP partial Spearman ρ, 0.19 [95% CI, 0.09-0.27; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;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}

{"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}

{"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}

{"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;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}

{"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}