{"title":"Toward Antifragility-Calling Health Care Systems to Evolve.","authors":"Moushumi Sur,Katri Typpo,Lara Shekerdemian,Satid Thammasitboon","doi":"10.1001/jamapediatrics.2025.4999","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4999","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"112 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752713","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 : 2025-12-15DOI: 10.1001/jamapediatrics.2025.5192
Jackson M A Hewitt,Sheri Madigan,Brae Anne McArthur
{"title":"Disentangling Maternal-Child Depression Dynamics Across Early Adolescence-Reply.","authors":"Jackson M A Hewitt,Sheri Madigan,Brae Anne McArthur","doi":"10.1001/jamapediatrics.2025.5192","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5192","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752661","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 : 2025-12-15DOI: 10.1001/jamapediatrics.2025.5181
Ashley A Foster,Anna M Cushing,Jennifer A Hoffmann,Katherine A Nash,Chuan-Mei Lee,Kenneth A Michelson
ImportancePediatric behavioral health conditions are common and may confer substantial health care costs and financial strain on families.ObjectiveTo quantify 2022 US pediatric behavioral health care expenditures, evaluate 2011 to 2022 changes in expenditures, and examine the association between child behavioral health spending and family financial burden.Design, Setting, and ParticipantsCross-sectional study of US children aged 6 to 17 years, using 2011-2022 Medical Expenditure Panel Survey household component files, with analysis performed from January 11, 2024, to October 15, 2025.ExposureExpenditure trends analysis included year. Family financial burden analysis included child behavioral health spending.Main Outcomes and MeasuresBehavioral health care and overall pediatric health care spending was totaled for 2022, using survey-weighted linear regression models to estimate trends. The association between child behavioral health spending and high family financial burden (sliding-scale income-based threshold) and extreme financial burden (>10% of income) was evaluated with weighted logistic regression. Analyses were inflation adjusted.ResultsPediatric behavioral health care expenditures in 2022 totaled $41.8 billion (95% CI, $17.0-$66.7 billion). The proportion of pediatric care expenditures for behavioral health increased from 22.4% in 2011 to 40.2% in 2022. Simultaneously, pediatric behavioral health out-of-pocket spending increased from $2.1 to $2.9 billion, by 6.4% annually (95% CI, 3.5%-9.0%). For families with at least 1 child with behavioral health spending, 12.5% of out-of-pocket spending among families with high financial burden and 14.4% of out-of-pocket spending among families with extreme financial burden were for child behavioral health care. Having a child with behavioral health spending was associated with high family financial burden (adjusted odds ratio, 1.60; 95% CI, 1.44-1.78) and extreme family financial burden (adjusted odds ratio, 1.42; 95% CI, 1.22-1.65).Conclusions and RelevanceBehavioral health expenditures nearly doubled to 40% of US child health spending by 2022. Behavioral health spending was associated with high family financial burden, which reflects increased demand and cost for services and supports expanding access through insurance coverage and clinician availability.
{"title":"Expenditures for Pediatric Behavioral Health Care Over Time and Estimated Family Financial Burden.","authors":"Ashley A Foster,Anna M Cushing,Jennifer A Hoffmann,Katherine A Nash,Chuan-Mei Lee,Kenneth A Michelson","doi":"10.1001/jamapediatrics.2025.5181","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5181","url":null,"abstract":"ImportancePediatric behavioral health conditions are common and may confer substantial health care costs and financial strain on families.ObjectiveTo quantify 2022 US pediatric behavioral health care expenditures, evaluate 2011 to 2022 changes in expenditures, and examine the association between child behavioral health spending and family financial burden.Design, Setting, and ParticipantsCross-sectional study of US children aged 6 to 17 years, using 2011-2022 Medical Expenditure Panel Survey household component files, with analysis performed from January 11, 2024, to October 15, 2025.ExposureExpenditure trends analysis included year. Family financial burden analysis included child behavioral health spending.Main Outcomes and MeasuresBehavioral health care and overall pediatric health care spending was totaled for 2022, using survey-weighted linear regression models to estimate trends. The association between child behavioral health spending and high family financial burden (sliding-scale income-based threshold) and extreme financial burden (>10% of income) was evaluated with weighted logistic regression. Analyses were inflation adjusted.ResultsPediatric behavioral health care expenditures in 2022 totaled $41.8 billion (95% CI, $17.0-$66.7 billion). The proportion of pediatric care expenditures for behavioral health increased from 22.4% in 2011 to 40.2% in 2022. Simultaneously, pediatric behavioral health out-of-pocket spending increased from $2.1 to $2.9 billion, by 6.4% annually (95% CI, 3.5%-9.0%). For families with at least 1 child with behavioral health spending, 12.5% of out-of-pocket spending among families with high financial burden and 14.4% of out-of-pocket spending among families with extreme financial burden were for child behavioral health care. Having a child with behavioral health spending was associated with high family financial burden (adjusted odds ratio, 1.60; 95% CI, 1.44-1.78) and extreme family financial burden (adjusted odds ratio, 1.42; 95% CI, 1.22-1.65).Conclusions and RelevanceBehavioral health expenditures nearly doubled to 40% of US child health spending by 2022. Behavioral health spending was associated with high family financial burden, which reflects increased demand and cost for services and supports expanding access through insurance coverage and clinician availability.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"20 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752698","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 : 2025-12-08DOI: 10.1001/jamapediatrics.2025.4801
Sara B DeMauro,Haresh Kirpalani,Susan Hintz,Kristi L Watterberg,Victoria Watson,Jean Lowe,Seetha Shankaran,Sanjay Chawla,Betty Vohr,Michael E Msall,Carl T D'Angio,Bradley A Yoder,Khanh Lai,Sarah Winter,Tarah T Colaizy,Stephanie L Merhar,Kristina Ziolkowski,Carla M Bann,Marissa Trotta,Jamie E Newman,Michele C Walsh,Rosemary D Higgins,Tanya E Cahill,Andrea F Duncan,Deanne E Wilson-Costello,Myriam Peralta-Carcelen,Hope Arnold,Ricardo A Mosquera,Roy J Heyne,Janell Fuller,Elisabeth C McGowan,Brenna Cavanaugh,Heidi M Harmon,Nathalie L Maitre,Mary Lauren Neel,Krisa P Van Meurs,Laurie A Richards,Howard W Kilbride,Abbey C Hines,Girija Natarajan,Andrea Trembath,Kristen L Benninger,Kalpashri Kesavan,William F Malcolm,Dinorah Zanger,Ann Marie Reynolds,Martha Carlson,Abhik Das,
ImportanceBronchopulmonary dysplasia (BPD) is the most common in-hospital morbidity of prematurity, associated with significant long-term medical and neurodevelopmental sequelae and health resource utilization. The Neonatal Research Network (NRN) Hydrocortisone for BPD Trial evaluated the efficacy and safety of hydrocortisone to prevent BPD in high-risk very preterm infants; the impact of hydrocortisone on school-age outcomes in this trial cohort is previously unreported.ObjectiveTo evaluate the impact of neonatal hydrocortisone treatment on early school-age functional motor, cognitive, academic, and pulmonary outcomes among children who participated in the Hydrocortisone for BPD Trial.Design, Setting, and ParticipantsThis prospective long-term cohort study is a follow-up of a randomized clinical trial, the Hydrocortisone for BPD Trial, conducted at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development NRN. Participants, enrolled from August 2011 to February 2018, included intubated infants who had been born before 30 weeks' gestational age and had been mechanically ventilated for at least 7 days by postnatal day 14 to 28. They were eligible for a single, in-person, early school-age visit between corrected age 5 years 0 months and 7 years 11 months, conducted from September 2017 to July 2024. Data analysis was performed from July 2024 to September 2025.InterventionParticipants were randomized to a 10-day tapering course of hydrocortisone or placebo beginning at 14 to 28 postnatal days.Main Outcomes and MeasuresEarly school-age study visits were performed by certified, masked assessors. The primary outcome of functional impairment was defined as any of the following: cognitive delay, motor delay, academic delay, or poor functional exercise capacity.ResultsThe primary outcome was available for 545 of 674 eligible children (80.9%), including 272 children in the hydrocortisone group (152 [55.9%] female; mean [SD] gestational age, 24.9 [1.5] weeks; mean [SD] age at visit, 5.3 [0.6] years) and 273 in the placebo group (108 [39.6%] female; mean [SD] gestational age, 24.8 [1.5] weeks; mean [SD] age at visit, 5.4 [0.6] years). There was no difference in the rate of functional impairment between the hydrocortisone group (194 of 272 children [71.3%]) and the placebo group (200 of 273 children [73.3%]) (adjusted relative risk, 0.99; 95% CI, 0.89-1.10), nor were there differences in the rates of the individual components. Motor delay was the most common impairment (308 of 510 children [60.4%]), followed by poor functional exercise capacity (175 of 484 children [36.2%]).Conclusions and RelevanceIn this study, neonatal hydrocortisone treatment of preterm infants with high risk for BPD did not impact functional impairment or its components; nearly three-quarters of the children demonstrated functional impairment at school age.Trial RegistrationClinicalTrials.gov Identifier: NCT01353313.
{"title":"Hydrocortisone in Preterm Infants and School-Age Functional Outcomes: Follow-Up of a Randomized Clinical Trial.","authors":"Sara B DeMauro,Haresh Kirpalani,Susan Hintz,Kristi L Watterberg,Victoria Watson,Jean Lowe,Seetha Shankaran,Sanjay Chawla,Betty Vohr,Michael E Msall,Carl T D'Angio,Bradley A Yoder,Khanh Lai,Sarah Winter,Tarah T Colaizy,Stephanie L Merhar,Kristina Ziolkowski,Carla M Bann,Marissa Trotta,Jamie E Newman,Michele C Walsh,Rosemary D Higgins,Tanya E Cahill,Andrea F Duncan,Deanne E Wilson-Costello,Myriam Peralta-Carcelen,Hope Arnold,Ricardo A Mosquera,Roy J Heyne,Janell Fuller,Elisabeth C McGowan,Brenna Cavanaugh,Heidi M Harmon,Nathalie L Maitre,Mary Lauren Neel,Krisa P Van Meurs,Laurie A Richards,Howard W Kilbride,Abbey C Hines,Girija Natarajan,Andrea Trembath,Kristen L Benninger,Kalpashri Kesavan,William F Malcolm,Dinorah Zanger,Ann Marie Reynolds,Martha Carlson,Abhik Das, ","doi":"10.1001/jamapediatrics.2025.4801","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4801","url":null,"abstract":"ImportanceBronchopulmonary dysplasia (BPD) is the most common in-hospital morbidity of prematurity, associated with significant long-term medical and neurodevelopmental sequelae and health resource utilization. The Neonatal Research Network (NRN) Hydrocortisone for BPD Trial evaluated the efficacy and safety of hydrocortisone to prevent BPD in high-risk very preterm infants; the impact of hydrocortisone on school-age outcomes in this trial cohort is previously unreported.ObjectiveTo evaluate the impact of neonatal hydrocortisone treatment on early school-age functional motor, cognitive, academic, and pulmonary outcomes among children who participated in the Hydrocortisone for BPD Trial.Design, Setting, and ParticipantsThis prospective long-term cohort study is a follow-up of a randomized clinical trial, the Hydrocortisone for BPD Trial, conducted at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development NRN. Participants, enrolled from August 2011 to February 2018, included intubated infants who had been born before 30 weeks' gestational age and had been mechanically ventilated for at least 7 days by postnatal day 14 to 28. They were eligible for a single, in-person, early school-age visit between corrected age 5 years 0 months and 7 years 11 months, conducted from September 2017 to July 2024. Data analysis was performed from July 2024 to September 2025.InterventionParticipants were randomized to a 10-day tapering course of hydrocortisone or placebo beginning at 14 to 28 postnatal days.Main Outcomes and MeasuresEarly school-age study visits were performed by certified, masked assessors. The primary outcome of functional impairment was defined as any of the following: cognitive delay, motor delay, academic delay, or poor functional exercise capacity.ResultsThe primary outcome was available for 545 of 674 eligible children (80.9%), including 272 children in the hydrocortisone group (152 [55.9%] female; mean [SD] gestational age, 24.9 [1.5] weeks; mean [SD] age at visit, 5.3 [0.6] years) and 273 in the placebo group (108 [39.6%] female; mean [SD] gestational age, 24.8 [1.5] weeks; mean [SD] age at visit, 5.4 [0.6] years). There was no difference in the rate of functional impairment between the hydrocortisone group (194 of 272 children [71.3%]) and the placebo group (200 of 273 children [73.3%]) (adjusted relative risk, 0.99; 95% CI, 0.89-1.10), nor were there differences in the rates of the individual components. Motor delay was the most common impairment (308 of 510 children [60.4%]), followed by poor functional exercise capacity (175 of 484 children [36.2%]).Conclusions and RelevanceIn this study, neonatal hydrocortisone treatment of preterm infants with high risk for BPD did not impact functional impairment or its components; nearly three-quarters of the children demonstrated functional impairment at school age.Trial RegistrationClinicalTrials.gov Identifier: NCT01353313.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"20 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696782","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 : 2025-12-08DOI: 10.1001/jamapediatrics.2025.4996
Alexander I Parry
{"title":"Why We Should Defend the Consumer Product Safety Commission.","authors":"Alexander I Parry","doi":"10.1001/jamapediatrics.2025.4996","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4996","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696785","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}
ImportanceRussia first invaded Ukraine in 2014, annexing the Crimean Peninsula and occupying parts of eastern Ukraine. On February 24, 2022, Russia launched a full-scale invasion that is currently ongoing. Despite the chronic nature of the armed conflict, evidence of its cumulative impact on adolescent mental health since 2014 remains limited.ObjectiveTo assess the prevalence of wartime traumatic stressors, posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and suicidality and to examine the differential associations of war exposure with adolescent mental health.Design, Setting, and ParticipantsThe Ukraine Adolescent Mental Health Study is a repeated cross-sectional study based on 2 school surveys conducted in 2016-2017 (n = 2766) and again in 2023-2024 (n = 2720). Adolescents aged 11 to 17 years (grades 6 to 9) living in Ukraine were recruited from 2 regions: Donetsk and Kirovograd. Data were analyzed from January 13, 2025, to May 28, 2025.ExposureFirst phase (2014) and second phase (2022) of the Russian invasion.Main Outcomes and MeasuresAdolescents self-reported wartime traumatic stressors, PTSD symptoms, depressive symptoms, suicidal ideation, and suicide attempts using standardized tools. The association between demographic variables and wartime traumatic stressors, mental health symptoms, and suicidality were also evaluated.ResultsA total of 5486 adolescent participants residing in Ukraine after 2 phases of the Russian invasion were included in the analyses, of whom 2907 (53.0%) were female; the mean (SD) age was 13.4 (1.7) years. Adolescents exposed to the second phase of the invasion experienced high levels of PTSD symptoms and depressive symptoms, with particularly high rates among adolescents who were living in the war-affected region during the first phase of the invasion (PTSD symptoms: 180 of 1122 participants [16.0%]; odds ratio, 14.08 [95% CI, 8.36-23.72]; severe depressive symptoms: 118 of 1122 participants [10.5%]; odds ratio, 4.83 [95% CI, 3.28-7.11]) compared with adolescents who had no war exposure. War exposure was associated with suicidality in all study groups. A cumulative association was observed between wartime traumatic stressors and mental health outcomes.Conclusions and RelevanceThe findings of this cross-sectional study suggest that the Russian-Ukrainian war has had a psychological toll on Ukrainian adolescents, indicating long-term consequences for their mental health, resilience, and development. These findings indicate an urgent need to prioritize and scale up mental health interventions to address the needs of adolescents during the ongoing war.
{"title":"Mental Health of Ukrainian Adolescents After Russian Invasions.","authors":"Andre Sourander,Sanju Silwal,Minja Westerlund,Matthew Hodes,Emmi Heinonen,Susanna Hinkka-Yli-Salomäki,Yuliia Yaschchyshyna,Gennadiy Putyatin,James Scott,Norbert Skokauskas,Olga Osokina","doi":"10.1001/jamapediatrics.2025.5094","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5094","url":null,"abstract":"ImportanceRussia first invaded Ukraine in 2014, annexing the Crimean Peninsula and occupying parts of eastern Ukraine. On February 24, 2022, Russia launched a full-scale invasion that is currently ongoing. Despite the chronic nature of the armed conflict, evidence of its cumulative impact on adolescent mental health since 2014 remains limited.ObjectiveTo assess the prevalence of wartime traumatic stressors, posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and suicidality and to examine the differential associations of war exposure with adolescent mental health.Design, Setting, and ParticipantsThe Ukraine Adolescent Mental Health Study is a repeated cross-sectional study based on 2 school surveys conducted in 2016-2017 (n = 2766) and again in 2023-2024 (n = 2720). Adolescents aged 11 to 17 years (grades 6 to 9) living in Ukraine were recruited from 2 regions: Donetsk and Kirovograd. Data were analyzed from January 13, 2025, to May 28, 2025.ExposureFirst phase (2014) and second phase (2022) of the Russian invasion.Main Outcomes and MeasuresAdolescents self-reported wartime traumatic stressors, PTSD symptoms, depressive symptoms, suicidal ideation, and suicide attempts using standardized tools. The association between demographic variables and wartime traumatic stressors, mental health symptoms, and suicidality were also evaluated.ResultsA total of 5486 adolescent participants residing in Ukraine after 2 phases of the Russian invasion were included in the analyses, of whom 2907 (53.0%) were female; the mean (SD) age was 13.4 (1.7) years. Adolescents exposed to the second phase of the invasion experienced high levels of PTSD symptoms and depressive symptoms, with particularly high rates among adolescents who were living in the war-affected region during the first phase of the invasion (PTSD symptoms: 180 of 1122 participants [16.0%]; odds ratio, 14.08 [95% CI, 8.36-23.72]; severe depressive symptoms: 118 of 1122 participants [10.5%]; odds ratio, 4.83 [95% CI, 3.28-7.11]) compared with adolescents who had no war exposure. War exposure was associated with suicidality in all study groups. A cumulative association was observed between wartime traumatic stressors and mental health outcomes.Conclusions and RelevanceThe findings of this cross-sectional study suggest that the Russian-Ukrainian war has had a psychological toll on Ukrainian adolescents, indicating long-term consequences for their mental health, resilience, and development. These findings indicate an urgent need to prioritize and scale up mental health interventions to address the needs of adolescents during the ongoing war.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696787","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 : 2025-12-08DOI: 10.1001/jamapediatrics.2025.5087
Ning Lyu,Sebastian Schneeweiss,Florence T Bourgeois,Timothy J Savage
{"title":"US Food and Drug Administration Approval of Biologic Drugs for Use in Children and Adolescents.","authors":"Ning Lyu,Sebastian Schneeweiss,Florence T Bourgeois,Timothy J Savage","doi":"10.1001/jamapediatrics.2025.5087","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5087","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"136 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696792","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：