Pub Date : 2025-04-25DOI: 10.1542/peds.2024-069111
Hannah K Bassett,Suchitra Rao,Jimmy Beck,Patrick W Brady,Ravi Jhaveri,Torsten Joerger,Danni Liang,Ricardo Quinonez,Alaina Shine,Joanna Malec,Brian P Lucas,Alan R Schroeder
BACKGROUND AND OBJECTIVESAlthough national recommendations advise antivirals for all hospitalized children with influenza, this recommendation is not supported by high-quality evidence like a randomized clinical trial, and recent data suggest nonadherence to guidelines. Our objective was to describe clinician treatment preferences for oseltamivir in hospitalized children.METHODSThis cross-sectional survey of pediatricians from 5 specialties was conducted at 7 US children's hospitals from March to June 2024. Four clinical vignettes meeting 2023 American Academy of Pediatrics (AAP) criteria for antiviral treatment were included. Our primary outcome was the average proportion of vignettes for which respondents recommended oseltamivir.RESULTSOf 1841 invited participants, 787 (42.7%) completed surveys. Participants were likely to recommend oseltamivir for 49.5% (95% CI, 47.0%-51.9%) of cases; this varied by site from 43.5% to 64.2% and by specialty from 41.6% (hospital medicine) to 70.9% (infectious disease). Longer duration of symptoms and less oxygen support significantly decreased the likelihood of recommending oseltamivir. Awareness of AAP recommendations increased the likelihood of recommending treatment, although aware respondents did not recommend treatment in 38% of cases. Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important.CONCLUSIONSOur results demonstrate nonadherence to national recommendations and variability in oseltamivir treatment for children hospitalized with influenza, indicating uncertainty and disagreement regarding which patients benefit from antivirals. A randomized controlled trial of oseltamivir in hospitalized children is needed to help strengthen current influenza treatment recommendations and inform clinicians of treatment benefit in specific pediatric populations.
{"title":"Variability of Clinician Recommendations for Oseltamivir in Children Hospitalized With Influenza.","authors":"Hannah K Bassett,Suchitra Rao,Jimmy Beck,Patrick W Brady,Ravi Jhaveri,Torsten Joerger,Danni Liang,Ricardo Quinonez,Alaina Shine,Joanna Malec,Brian P Lucas,Alan R Schroeder","doi":"10.1542/peds.2024-069111","DOIUrl":"https://doi.org/10.1542/peds.2024-069111","url":null,"abstract":"BACKGROUND AND OBJECTIVESAlthough national recommendations advise antivirals for all hospitalized children with influenza, this recommendation is not supported by high-quality evidence like a randomized clinical trial, and recent data suggest nonadherence to guidelines. Our objective was to describe clinician treatment preferences for oseltamivir in hospitalized children.METHODSThis cross-sectional survey of pediatricians from 5 specialties was conducted at 7 US children's hospitals from March to June 2024. Four clinical vignettes meeting 2023 American Academy of Pediatrics (AAP) criteria for antiviral treatment were included. Our primary outcome was the average proportion of vignettes for which respondents recommended oseltamivir.RESULTSOf 1841 invited participants, 787 (42.7%) completed surveys. Participants were likely to recommend oseltamivir for 49.5% (95% CI, 47.0%-51.9%) of cases; this varied by site from 43.5% to 64.2% and by specialty from 41.6% (hospital medicine) to 70.9% (infectious disease). Longer duration of symptoms and less oxygen support significantly decreased the likelihood of recommending oseltamivir. Awareness of AAP recommendations increased the likelihood of recommending treatment, although aware respondents did not recommend treatment in 38% of cases. Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important.CONCLUSIONSOur results demonstrate nonadherence to national recommendations and variability in oseltamivir treatment for children hospitalized with influenza, indicating uncertainty and disagreement regarding which patients benefit from antivirals. A randomized controlled trial of oseltamivir in hospitalized children is needed to help strengthen current influenza treatment recommendations and inform clinicians of treatment benefit in specific pediatric populations.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-24DOI: 10.1542/peds.2024-068459
Allyn Bandell,Lucia Giles,Penélope Cervelo Bouzo,Gillian C Sibbring,Jon Maniaci,Henry Wojtczak,Andrew G Sokolow
CONTEXTThe US Advisory Committee on Immunization Practices states a contraindication for live attenuated influenza vaccine (LAIV) use in children aged 2 to 4 years with asthma or recurrent wheeze plus a precaution, defined as defer vaccine use, in those aged >5 years with asthma.OBJECTIVEWe assessed the certainty of evidence on the safety of LAIV vs inactivated influenza vaccine (IIV) or no vaccine, or before vs after LAIV, in eligible individuals with asthma and/or wheeze.DATA SOURCESEmbase, MEDLINE, CCTR, and CDSR were searched for eligible studies (database inception to August 27, 2024) via Ovid/Elsevier.STUDY SELECTIONScreening (title/abstract and full text) and data extraction were performed by a single reviewer; an independent reviewer screened 10%. Risk of bias (ROB) was assessed using ROB2 and ROBINS-I. Evidence certainty was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.RESULTSSearches yielded 24 eligible studies (28 publications); 15 comparative studies were included in the GRADE assessment. No difference in patient-reported safety outcomes was reported in 86.7% of studies comparing LAIV and IIV (all ages and disease severities; "very low" to "moderate" certainty evidence). A higher instance of rhinitis and a lower incidence of inpatient/emergency department visits and wheezing were reported after LAIV vs IIV. Evidence was mostly downgraded for ROB, imprecision, and indirectness. Similar results were observed for all comparisons.LIMITATIONSThe heterogeneity of identified outcomes precluded a meta-analysis.CONCLUSIONSThis suggests comparable safety outcomes with LAIV vs IIV in persons with asthma and/or recurrent wheeze, irrespective of disease severity.
{"title":"Safety of LAIV Vaccination in Asthma or Wheeze: A Systematic Review and GRADE Assessment.","authors":"Allyn Bandell,Lucia Giles,Penélope Cervelo Bouzo,Gillian C Sibbring,Jon Maniaci,Henry Wojtczak,Andrew G Sokolow","doi":"10.1542/peds.2024-068459","DOIUrl":"https://doi.org/10.1542/peds.2024-068459","url":null,"abstract":"CONTEXTThe US Advisory Committee on Immunization Practices states a contraindication for live attenuated influenza vaccine (LAIV) use in children aged 2 to 4 years with asthma or recurrent wheeze plus a precaution, defined as defer vaccine use, in those aged >5 years with asthma.OBJECTIVEWe assessed the certainty of evidence on the safety of LAIV vs inactivated influenza vaccine (IIV) or no vaccine, or before vs after LAIV, in eligible individuals with asthma and/or wheeze.DATA SOURCESEmbase, MEDLINE, CCTR, and CDSR were searched for eligible studies (database inception to August 27, 2024) via Ovid/Elsevier.STUDY SELECTIONScreening (title/abstract and full text) and data extraction were performed by a single reviewer; an independent reviewer screened 10%. Risk of bias (ROB) was assessed using ROB2 and ROBINS-I. Evidence certainty was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.RESULTSSearches yielded 24 eligible studies (28 publications); 15 comparative studies were included in the GRADE assessment. No difference in patient-reported safety outcomes was reported in 86.7% of studies comparing LAIV and IIV (all ages and disease severities; \"very low\" to \"moderate\" certainty evidence). A higher instance of rhinitis and a lower incidence of inpatient/emergency department visits and wheezing were reported after LAIV vs IIV. Evidence was mostly downgraded for ROB, imprecision, and indirectness. Similar results were observed for all comparisons.LIMITATIONSThe heterogeneity of identified outcomes precluded a meta-analysis.CONCLUSIONSThis suggests comparable safety outcomes with LAIV vs IIV in persons with asthma and/or recurrent wheeze, irrespective of disease severity.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"8 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-24DOI: 10.1542/peds.2024-070120
Annika M Hofstetter,Melissa S Stockwell,Kristina A Bryant
{"title":"LAIV Use for Children With Asthma or Recurrent Wheeze: Time to Move the Needle?","authors":"Annika M Hofstetter,Melissa S Stockwell,Kristina A Bryant","doi":"10.1542/peds.2024-070120","DOIUrl":"https://doi.org/10.1542/peds.2024-070120","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"2021 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-24DOI: 10.1542/peds.2025-071260
Alexandra L Coria,Brian Wahl,Naveen Thacker,Rachel Vreeman,Liesl Zühlke
For more than 60 years, the United States Agency for International Development (USAID) has been a major funder of efforts to improve maternal and child health (MCH) across many low- and middle-income countries (LMICs). From 2000 to 2022, the global under-five mortality rate declined from 76 to 37 deaths per 1000 live births.1. Though this progress stemmed from the cumulative efforts of many organizations, governments, and health care workers, a 2022 causal analysis by Weiss et al. (the most recent analysis available), demonstrated that from 2000 to 2016, high USAID funding for MCH and malaria independently reduced under-five mortality by more than 20 deaths per 1000 live births compared with control regions.2.
{"title":"USAID's Role in Saving Children's Lives: Past Legacy and Future Directions.","authors":"Alexandra L Coria,Brian Wahl,Naveen Thacker,Rachel Vreeman,Liesl Zühlke","doi":"10.1542/peds.2025-071260","DOIUrl":"https://doi.org/10.1542/peds.2025-071260","url":null,"abstract":"For more than 60 years, the United States Agency for International Development (USAID) has been a major funder of efforts to improve maternal and child health (MCH) across many low- and middle-income countries (LMICs). From 2000 to 2022, the global under-five mortality rate declined from 76 to 37 deaths per 1000 live births.1. Though this progress stemmed from the cumulative efforts of many organizations, governments, and health care workers, a 2022 causal analysis by Weiss et al. (the most recent analysis available), demonstrated that from 2000 to 2016, high USAID funding for MCH and malaria independently reduced under-five mortality by more than 20 deaths per 1000 live births compared with control regions.2.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"71 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-23DOI: 10.1542/peds.2024-069668
Marije Hogeveen,Lotty Hooft,Wes Onland
CONTEXTHypothermia after very preterm birth, typically defined as a temperature less than 36 °C, is variably linked to neonatal mortality and morbidities.OBJECTIVETo examine the association between admission hypothermia and adverse outcomes in very preterm infants with a gestational age (GA) of less than 32 weeks.DATA SOURCESCENTRAL, MEDLINE, and Embase from inception to February 18, 2024.STUDY SELECTIONObservational or randomized designs reporting on the association between admission temperature and adverse outcomes in very preterm infants.DATA EXTRACTIONTwo reviewers screened abstracts and full texts, extracted the data, and assessed the risk of bias, following Meta-analysis Of Observational Studies in Epidemiology /Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We planned to perform random-effects meta-analyses, subgroup (GA, birthweight [BW], and income), sensitivity analysis (NOS, study type), and meta-regression (GA, BW). Outcomes included mortality and neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy (ROP), and sepsis.RESULTSThis review included 32 studies with >300 000 infants. The mean hypothermia rate was 42% (range 14%-88%). Hypothermia was associated with increased mortality (crude odds ratio [cOR] [95% CI] 2.02[1.84;2.21]; adjusted OR 1.55[1.29;1.87]). Subgroup and sensitivity analyses upheld these results. Meta-regression analysis showed an inversed relationship between effect size and BW. Hypothermia was associated with higher risks of BPD (cOR 1.13[1.01;1.27]), IVH (cOR 1.37[1.17;1.61]), ROP (cOR 1.55[1.41;1.69]), and sepsis (cOR 1.32[1.16;1.51]).LIMITATIONSOnly observational studies were included.CONCLUSIONSHypothermia is associated with increased mortality and morbidity in very preterm infants. The strength of this association may be influenced by BW, definitions of hypothermia and outcomes, and exclusion criteria. Given the robustness of our results and our sample size, identical cohort studies might not provide different insights.
{"title":"Hypothermia and Adverse Outcomes in Very Preterm Infants: A Systematic Review.","authors":"Marije Hogeveen,Lotty Hooft,Wes Onland","doi":"10.1542/peds.2024-069668","DOIUrl":"https://doi.org/10.1542/peds.2024-069668","url":null,"abstract":"CONTEXTHypothermia after very preterm birth, typically defined as a temperature less than 36 °C, is variably linked to neonatal mortality and morbidities.OBJECTIVETo examine the association between admission hypothermia and adverse outcomes in very preterm infants with a gestational age (GA) of less than 32 weeks.DATA SOURCESCENTRAL, MEDLINE, and Embase from inception to February 18, 2024.STUDY SELECTIONObservational or randomized designs reporting on the association between admission temperature and adverse outcomes in very preterm infants.DATA EXTRACTIONTwo reviewers screened abstracts and full texts, extracted the data, and assessed the risk of bias, following Meta-analysis Of Observational Studies in Epidemiology /Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We planned to perform random-effects meta-analyses, subgroup (GA, birthweight [BW], and income), sensitivity analysis (NOS, study type), and meta-regression (GA, BW). Outcomes included mortality and neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy (ROP), and sepsis.RESULTSThis review included 32 studies with >300 000 infants. The mean hypothermia rate was 42% (range 14%-88%). Hypothermia was associated with increased mortality (crude odds ratio [cOR] [95% CI] 2.02[1.84;2.21]; adjusted OR 1.55[1.29;1.87]). Subgroup and sensitivity analyses upheld these results. Meta-regression analysis showed an inversed relationship between effect size and BW. Hypothermia was associated with higher risks of BPD (cOR 1.13[1.01;1.27]), IVH (cOR 1.37[1.17;1.61]), ROP (cOR 1.55[1.41;1.69]), and sepsis (cOR 1.32[1.16;1.51]).LIMITATIONSOnly observational studies were included.CONCLUSIONSHypothermia is associated with increased mortality and morbidity in very preterm infants. The strength of this association may be influenced by BW, definitions of hypothermia and outcomes, and exclusion criteria. Given the robustness of our results and our sample size, identical cohort studies might not provide different insights.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"69 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-22DOI: 10.1542/peds.2025-071622
Christopher Kuo
When I was seven, my eldest brother, Sammy, was diagnosed with subacute sclerosing panencephalitis (SSPE) - a sequela of measles infection. He rapidly deteriorated into a vegetative state. Looking back, the bulk of my childhood consisted of mixing nasogastric feeds for him and assisting with his physical therapy alongside my grandfather to prevent worsening contractures. It was extremely traumatic, to say the least. Watching my own brother gradually lose his ability to speak, seeing his lifeless, glassy doll eyes, and witnessing his body become an empty vessel was devastating. He eventually became so cachectic that his bones and joints were accentuated. His body deteriorated, fingers fixed in constant flexion, and his limbs ridden with contractures. Sammy ultimately passed away when I was 17, after living for 10 years with SSPE.
{"title":"Vaccines Matter: Measles and Its Complications.","authors":"Christopher Kuo","doi":"10.1542/peds.2025-071622","DOIUrl":"https://doi.org/10.1542/peds.2025-071622","url":null,"abstract":"When I was seven, my eldest brother, Sammy, was diagnosed with subacute sclerosing panencephalitis (SSPE) - a sequela of measles infection. He rapidly deteriorated into a vegetative state. Looking back, the bulk of my childhood consisted of mixing nasogastric feeds for him and assisting with his physical therapy alongside my grandfather to prevent worsening contractures. It was extremely traumatic, to say the least. Watching my own brother gradually lose his ability to speak, seeing his lifeless, glassy doll eyes, and witnessing his body become an empty vessel was devastating. He eventually became so cachectic that his bones and joints were accentuated. His body deteriorated, fingers fixed in constant flexion, and his limbs ridden with contractures. Sammy ultimately passed away when I was 17, after living for 10 years with SSPE.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"91 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A few studies have reported immunoglobulin A nephropathy (IgAN) complications in pediatric patients with Crohn disease (CD). Additionally, reports of severe atopic dermatitis (AD) complicating CD with IgAN are rare. In this case report, we review the case of a 10-year-old boy with CD later complicated by IgAN and severe AD at various time points. In his treatment course, he required multiple concurrent therapies, including upadacitinib and infliximab, to achieve remission for all 3 conditions. This case reports successful simultaneous treatment with separate agents in a pediatric case of CD complicated by severe AD.
有少数研究报告了克罗恩病（CD）儿童患者的免疫球蛋白 A 肾病（IgAN）并发症。此外，CD并发严重特应性皮炎（AD）和IgAN的报道也很少见。在本病例报告中，我们回顾了一名 10 岁男孩的病例，他患有 CD，后来在不同时间并发了 IgAN 和严重的 AD。在治疗过程中，他需要同时接受多种治疗，包括达帕替尼（upadacitinib）和英夫利昔单抗（infliximab），才能使这三种疾病都得到缓解。本病例报告了在一例CD并发严重AD的儿科病例中同时使用不同药物治疗的成功案例。
{"title":"Pediatric Case of Crohn Disease, Immunoglobulin A Nephropathy, and Atopic Dermatitis.","authors":"Yoshihiko Sugino,Hideki Ban,Yuichiro Yoshino,Yugo Takaki,Akio Furuse","doi":"10.1542/peds.2024-068803","DOIUrl":"https://doi.org/10.1542/peds.2024-068803","url":null,"abstract":"A few studies have reported immunoglobulin A nephropathy (IgAN) complications in pediatric patients with Crohn disease (CD). Additionally, reports of severe atopic dermatitis (AD) complicating CD with IgAN are rare. In this case report, we review the case of a 10-year-old boy with CD later complicated by IgAN and severe AD at various time points. In his treatment course, he required multiple concurrent therapies, including upadacitinib and infliximab, to achieve remission for all 3 conditions. This case reports successful simultaneous treatment with separate agents in a pediatric case of CD complicated by severe AD.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-21DOI: 10.1542/peds.2024-069973
Emma Hymel,Josiane Kabayundo,Krishtee Napit,Shinobu Watanabe-Galloway
BACKGROUNDCancer is the leading cause of death by disease among US children. While previous studies have examined the impact of poverty on pediatric cancer outcomes, most relied on single time point measures, which may not capture the long-term, systemic effects of poverty. Persistent poverty, defined as having 20% or more of an area's population below the poverty level for 30 years, represents a more comprehensive measure of sustained socioeconomic disadvantage.METHODSIn this population-based study, we used Surveillance, Epidemiology, and End Results (SEER)-22 Registries Incidence Data with Census Tract Attributes Database data. Primary cases of cancer diagnosed among children from 2006 to 2020 were included. Cox proportional hazards models were used to compute the association between persistent poverty and (1) early mortality (death from cancer within 3 months of diagnosis) and (2) overall cancer-specific mortality.RESULTSIn total, 97 132 children were included in our study; 12.63% resided in a persistent-poverty neighborhood at diagnosis. In the adjusted models, living in a persistent-poverty neighborhood was associated with a higher risk of early mortality (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.10-1.45) and a higher risk of overall cancer death (aHR, 1.15; 95% CI, 1.10-1.21). Persistent poverty was associated with survival for children with leukemias (aHR, 1.20; 95% CI, 1.09-1.31), central nervous system tumors (aHR, 1.14; 95% CI, 1.04-1.26), and hepatic tumors (aHR, 1.37; 95% CI, 1.01-1.85).CONCLUSIONSOur study observed increased risk of cancer death among children in persistent-poverty neighborhoods. Continued investment and research are critical to developing effective strategies that reduce disparities and improve outcomes for pediatric cancer patients affected by persistent poverty.
{"title":"Persistent Poverty and Pediatric Cancer Survival.","authors":"Emma Hymel,Josiane Kabayundo,Krishtee Napit,Shinobu Watanabe-Galloway","doi":"10.1542/peds.2024-069973","DOIUrl":"https://doi.org/10.1542/peds.2024-069973","url":null,"abstract":"BACKGROUNDCancer is the leading cause of death by disease among US children. While previous studies have examined the impact of poverty on pediatric cancer outcomes, most relied on single time point measures, which may not capture the long-term, systemic effects of poverty. Persistent poverty, defined as having 20% or more of an area's population below the poverty level for 30 years, represents a more comprehensive measure of sustained socioeconomic disadvantage.METHODSIn this population-based study, we used Surveillance, Epidemiology, and End Results (SEER)-22 Registries Incidence Data with Census Tract Attributes Database data. Primary cases of cancer diagnosed among children from 2006 to 2020 were included. Cox proportional hazards models were used to compute the association between persistent poverty and (1) early mortality (death from cancer within 3 months of diagnosis) and (2) overall cancer-specific mortality.RESULTSIn total, 97 132 children were included in our study; 12.63% resided in a persistent-poverty neighborhood at diagnosis. In the adjusted models, living in a persistent-poverty neighborhood was associated with a higher risk of early mortality (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.10-1.45) and a higher risk of overall cancer death (aHR, 1.15; 95% CI, 1.10-1.21). Persistent poverty was associated with survival for children with leukemias (aHR, 1.20; 95% CI, 1.09-1.31), central nervous system tumors (aHR, 1.14; 95% CI, 1.04-1.26), and hepatic tumors (aHR, 1.37; 95% CI, 1.01-1.85).CONCLUSIONSOur study observed increased risk of cancer death among children in persistent-poverty neighborhoods. Continued investment and research are critical to developing effective strategies that reduce disparities and improve outcomes for pediatric cancer patients affected by persistent poverty.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"77 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-18DOI: 10.1542/peds.2024-068565
Megan Rose Curtis,Sarah Munroe,Breanne E Biondi,Andrea L Ciaranello,Benjamin P Linas,Rachel L Epstein
BACKGROUND AND OBJECTIVESPediatric HCV cases have increased in the United States. Guidelines recommend beginning treatment of HCV for children as young as 3 years old. However, no studies have evaluated pediatric linkage to HCV care and direct-acting antiviral (DAA) uptake on a national level. This study aims to characterize the HCV care cascade among a national cohort of children with HCV.METHODSThis retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. We analyzed TriNetX Research Network data, a US national electronic health records network. Primary HCV care cascade outcomes included the number of children diagnosed with HCV infection, linked to care, and prescribed DAAs. We assessed the association between race and ethnicity with linkage to care using logistic regression.RESULTSAmong 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA. Hispanic/Latinx children had double and white children had triple the odds of linkage compared with Black children (odds ratio [OR], 2.20; 95% CI, 1.05-4.59; OR, 3.44; 95% CI, 1.89-6.28) after adjusting for sex, birth cohort, and region.CONCLUSIONSPediatric access to HCV care remains low. Fewer than 1 in 3 children linked to HCV care and fewer than 1 in 8 were treated. This study uncovers racial and ethnic disparities in HCV care access. Targeting interventions toward increasing linkage to care could represent an opportunity to advance HCV elimination goals and reduce disparities.
{"title":"Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States.","authors":"Megan Rose Curtis,Sarah Munroe,Breanne E Biondi,Andrea L Ciaranello,Benjamin P Linas,Rachel L Epstein","doi":"10.1542/peds.2024-068565","DOIUrl":"https://doi.org/10.1542/peds.2024-068565","url":null,"abstract":"BACKGROUND AND OBJECTIVESPediatric HCV cases have increased in the United States. Guidelines recommend beginning treatment of HCV for children as young as 3 years old. However, no studies have evaluated pediatric linkage to HCV care and direct-acting antiviral (DAA) uptake on a national level. This study aims to characterize the HCV care cascade among a national cohort of children with HCV.METHODSThis retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. We analyzed TriNetX Research Network data, a US national electronic health records network. Primary HCV care cascade outcomes included the number of children diagnosed with HCV infection, linked to care, and prescribed DAAs. We assessed the association between race and ethnicity with linkage to care using logistic regression.RESULTSAmong 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA. Hispanic/Latinx children had double and white children had triple the odds of linkage compared with Black children (odds ratio [OR], 2.20; 95% CI, 1.05-4.59; OR, 3.44; 95% CI, 1.89-6.28) after adjusting for sex, birth cohort, and region.CONCLUSIONSPediatric access to HCV care remains low. Fewer than 1 in 3 children linked to HCV care and fewer than 1 in 8 were treated. This study uncovers racial and ethnic disparities in HCV care access. Targeting interventions toward increasing linkage to care could represent an opportunity to advance HCV elimination goals and reduce disparities.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"91 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-17DOI: 10.1542/peds.2024-069855
Kassondra M Little,Emily Speck,Christian D Pulcini,Marianna Paradise,Molly Rideout,William V Raszka
A healthy 13-year-old boy who resides in rural Vermont presented after witnessed, generalized seizure-like activity for approximately 2 minutes. He had been well until the development of right inguinal pain and rash 2 weeks before presentation, which had progressed to a 5-cm irregular, red, tender, and raised area that was unresponsive to 5 days of cephalexin. At the time of presentation, he was afebrile and hemodynamically stable and only responsive to localized stimuli. Initial laboratory evaluation, toxicology screening, and computed tomography of the head were all unremarkable. Ultrasonography of the inguinal lesion showed an abscess with subcutaneous edema and reactive lymphadenopathy. He did not have evidence of stroke or status epilepticus. Because of his persistent altered mental status, the patient was admitted to the pediatric intensive care unit, and pediatric infectious disease was consulted. A detailed history revealed he had extensive recent animal exposures that included bear, deer, dogs, chickens, and kittens. Cerebrospinal fluid (CSF) analysis showed 5 leukocytes (26% polymorphonuclear leukocyte), normal glucose, and slightly elevated protein. Video electroencephalogram demonstrated bilateral cerebral dysfunction, whereas the brain magnetic resonance imaging and magnetic resonance venogram scan results were normal. CSF culture and polymerase chain reaction results for bacterial and viral pathogens were negative. Fluid collected from the inguinal lesion showed neutrophils but no organisms. The following discussion describes this patient's full course, differential diagnoses, diagnostic workup with clinical reasoning, and final diagnosis.
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