Pediatrics最新文献

Intrauterine Ureaplasma infection is associated with chorioamnionitis and preterm birth. The difficulty of detecting Ureaplasma species by conventional culture methods makes definitive diagnosis of clinical infection challenging. Thus far, quantitative tests for Ureaplasma have been performed using adult cervical samples, amniotic fluid, and pediatric bronchial secretions, but quantification of bacterial count in central nervous system infections caused by Ureaplasma species has not been unreported. We report a case of culture-negative Ureaplasma meningitis in a preterm infant in whom novel techniques to identify this pathogen and quantify bacterial count were effective. We suspected meningitis based on a sustained reduction in cerebrospinal fluid (CSF) glucose levels. Multiple CSF cultures were sterile. We confirmed infection by Ureaplasma species using the melting temperature mapping method. Treatment with erythromycin and ciprofloxacin resulted in a gradual decrease in the bacterial count in the CSF to 0. Our study highlights the potential utility of the melting temperature mapping method as a new diagnostic tool for culture-negative Ureaplasma meningitis and establishes the utility of serial quantification of bacterial count to monitor response to therapy.

Background and objectives: Very low birth weight infants in the NICU are more susceptible to adverse outcomes. We recently described improving survival without major morbidity among very low birth weight infants in California. This study aims to examine whether this improvement was equitable across racial and ethnic groups.

Methods: We included 66 786 infants from the California Perinatal Quality Care Collaborative who weighed <1500 grams or were <29 weeks' gestational age at birth and were cared for between January 1, 2008 and December 31, 2021. We examined rates of survival without major morbidity over time, stratified by safety net NICUs (snNICUs), as well as racial and ethnic groups.

Results: Between 2008 and 2021, survival without major morbidity increased from 62.2% to 66.1% (P < .001), although improvement plateaued after 2017. All racial and ethnic groups saw improvement, with Native Hawaiian/Pacific Islander and Black infants improving the most (12.4% and 9.8%, respectively). However, during the last 3 years, Hispanic infants had the lowest rates of survival without major morbidity (64.3%), compared with non-Hispanic white (67.6%), Black (67.8%), Asian (68.9%), Native Hawaiian/Pacific Islander (68.5%), and American Indian/Alaskan Native (69.9%) infants. Black and Hispanic infants were disproportionately cared for in snNICUs, which experienced significantly lower survival without major morbidity than non-snNICUs at all time points.

Conclusions: We observed improvement in survival without major morbidity over 14 years, with progress stalling in recent years. Opportunities to address health inequities in NICU outcomes remain, particularly in snNICUs, while identifying strategies for continued improvement overall.

Background and objectives: Evidence is scarce on the clustering patterns of disordered eating dimensionsor symptoms and their effects on future cardiometabolic health. This study examines associations of disordered eating trajectory profiles (from 13 to 21 years), with BMI and related cardiometabolic features at ages 21, 24 and 27.

Methods: Participants are from the Epidemiological Health Investigation of Teenagers cohort (Porto, Portugal). At 13, 17 and 21 years, 3 Eating Disorder Inventory subscales were assessed (drive for thinness, bulimia and body dissatisfaction), and a latent class analysis derived trajectory profiles. Associations with BMI and having ≥1 metabolic syndrome feature at 21 (n = 1619), 24 (n = 916) and 27 years (n = 720) were tested using generalized linear models and binary logistic regressions.

Results: The following 4 profiles were obtained: "higher" levels (highest severity of symptoms at all ages, 16-19%), "increasing" (especially of body concerns, 26-28%), "decreasing" (18-19%), and "lower" (highest proportion of individuals with low/without disordered eating, 35-37%). Compared with the lower levels profile, both sexes with higher and increasing disordered eating presented heightened BMI at 21, 24 and 27 years. Women in the higher levels profile had higher odds of having ≥1 metabolic syndrome feature at 21 and 24 years, while men with higher and increasing disordered eating presented increased odds at 21, 24 and 27 years.

Conclusions: Individuals, particularly males, with higher or increasing disordered eating levels from 13 to 21 years of age presented a higher risk of worsened cardiometabolic health up to 6 years later in adulthood.

Context: The risk of early neurodevelopmental delay is increasingly recognized in children born moderate-to-late preterm (MLP; 32-36 weeks' gestation), but school-aged cognitive outcomes are unclear, particularly for domains such as executive function (EF).

Objective: To evaluate EF outcomes (attentional control, cognitive flexibility, and goal setting) in school-aged children born MLP compared with children born at term.

Data sources: Medline, Embase, PsycInfo, and Scopus.

Study selection: Studies assessing EF outcomes (overall EF, attentional control, cognitive flexibility, and goal setting) in children born MLP aged between 6 and 17 years, which included a term-born control group.

Data extraction: Two reviewers screened for eligibility and completed the risk of bias assessment using the Newcastle-Ottawa Scale, and 1 reviewer extracted data. Random effects meta-analyses were performed.

Results: Twelve studies were eligible for inclusion in the meta-analyses (2348 MLP children and 20 322 controls). Children born MLP had poorer overall EF compared with children born at term (standardized mean difference, -0.15, 95% confidence interval, -0.21 to -0.09; P < .0001; I2 = 47.59%). Similar conclusions were noted across the subdomains of attentional control, cognitive flexibility, and goal setting.

Limitations: Study methodologies and EF measures varied. Only a small number of studies met eligibility criteria and were from developed countries.

Conclusions: School-aged children born MLP may experience greater challenges in EF compared with term-born children. Further research is needed to investigate the potential impact these challenges have on functional outcomes such as academic achievement and social-emotional functioning.

The 2025 recommended childhood and adolescent immunization schedules have been approved by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Academy of Physician Associates, and National Association of Pediatric Nurse Practitioners. The schedules are revised annually to reflect current recommendations for the use of vaccines licensed by the US Food and Drug Administration.

Background: The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs).

Methods: We included children between 1 and 36 months of age undergoing bladder catheterization for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture result: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition.

Results: A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80-0.87) and 75% (95% confidence interval, 0.66-0.83), respectively.

Conclusions: Our findings suggest that for febrile children <36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in ∼20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs.

Cerebral/cortical visual impairment (CVI) is a leading cause of pediatric visual impairment in nations with developed economies and is increasing in those with developing economies. Because vision is the predominant sense used for learning, delay in diagnosis of CVI can negatively affect education, making early detection and management important. The American Academy of Pediatrics has published the policy statement "Visual System Assessment in Infants, Children, and Young Adults by Pediatricians" and an accompanying clinical report that are based on identifying potential causes of ocular visual impairment in children. Yet, routine vision screening may not accurately identify the brain-based visual impairment in children with CVI. Moreover, children with CVI often have medical complexity with other neurocognitive impairments and serious medical conditions that can make the diagnosis of CVI more difficult. Strategies are necessary for early identification of CVI to promote early diagnosis and referral for vision services that may allow a child with CVI to engage more fully in school, activities of daily living, vocational pursuits, and recreational activities. Knowledge of the characteristics of CVI as well as risk factors for CVI will assist the pediatrician in identifying children with CVI. This clinical report is complementary to previous vision screening policies, allowing both ocular and brain-based visual impairments in children to be identified and addressed. Pediatricians, other primary care physicians, pediatric ophthalmologists, neurologists, and other specialized pediatric eye care clinicians can identify children with CVI and coordinate effective evaluation, diagnosis, and referrals for vision services for these children.

Juvenile parkinsonism is an exceedingly rare condition in which clinical signs of parkinsonism manifest before 21 years of age. Although the genetic underpinnings of this disorder are increasingly recognized, the full range of inherited metabolic contributors remains undefined. We present the first case of levodopa-responsive juvenile parkinsonism associated with dihydropyrimidinase deficiency caused by a novel DPYS variant. A 13-year-old patient presented with rapid progression of dysphagia, dysarthria, and loss of ambulation over 18 months. Whole-exome sequencing revealed compound heterozygous variants in the DPYS gene (NM_001385: c.1393C>T, p.R465X, and c.905G>A, p.R302Q). In silico analysis predicted both variants to be pathogenic. Further urinary metabolome analysis demonstrated markedly elevated dihydrouracil and dihydrothymine levels, confirming impaired pyrimidine metabolism. Levodopa treatment effectively relieved the patient's motor symptoms. This report identifies DPYS as a novel genetic cause of juvenile parkinsonism and underscores the potential efficacy of levodopa therapy in managing motor dysfunction in DYPS-related parkinsonism.

Background and objectives: Maternal substance use during pregnancy heightens risk of sudden unexpected infant death (SUID), including through unsafe sleep practices. Families impacted by substance use frequently experience disproportionate social drivers of poor health and family vulnerability likely contributory to fatality risk. Characteristics of sleep-related SUID among infants born prenatally substance exposed versus nonexposed were compared to identify targeted prevention opportunities.

Methods: Using the Sudden Death in the Young Registry, we examined SUID with sleep-related death between 2015 and 2020 across infants prenatally exposed versus nonexposed. Distribution of sleep environment characteristics, social drivers of poor health, and family vulnerability factors were examined using descriptive statistics and χ2.

Results: Of 2010 infants who experienced sleep-related deaths, 283 (14%) were prenatally exposed. More than half of deaths involved an adult bed (52%, n = 1045) or surface sharing with an adult (53%, n = 1074). Supervisors of prenatally exposed infants were disproportionately impaired at infant death versus nonexposed (34%, n = 97 vs 16%, n = 279). Statistically significant associations between prenatal exposure history and vulnerability factors (insurance, child welfare involvement, intimate partner violence, health care barriers) were identified (P < .05).

Conclusions: Sleep-related SUID across infants prenatally exposed versus nonexposed differ in sleep environment characteristics and contributory social vulnerability. Disproportionate sleep environment hazards (surface sharing, supervisor impairment) are identified among prenatally exposed infants that should compel targeted prevention efforts, including safe sleep messaging, discouraging surface sharing, and engaging support persons during impairment periods. Addressing social needs and family vulnerability are also paramount to increase access to health care, safe sleep education, and material resource provision.