Pub Date : 2026-03-24DOI: 10.1542/peds.2025-075260
Katherine E Remick,Caleb E Ward,Rahel Berhane
{"title":"Are EMS Systems Ready to Meet the Needs of Children With Medical Complexity?","authors":"Katherine E Remick,Caleb E Ward,Rahel Berhane","doi":"10.1542/peds.2025-075260","DOIUrl":"https://doi.org/10.1542/peds.2025-075260","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"35 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502175","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 : 2026-03-24DOI: 10.1542/peds.2025-074802
Sriram Ramgopal,Carolyn Foster,Michelle L Macy,Christopher M Horvat,Rebecca E Cash,Julia A Heneghan,Allan M Joseph,Stephen Janofsky,Christian Martin-Gill
OBJECTIVEThe care of children with medical complexity (CMC) in the prehospital setting is recognized as a priority in consensus-based Emergency Medical Services (EMS) guidelines. We examined EMS use, care patterns, and outcomes for CMC, including cardiac arrest and mortality.METHODSWe performed a multi-EMS agency and multicenter study of pediatric transports, from the scene to the hospital, to 1 of 17 hospitals within an integrated health system. We identified CMC based on encounter-level diagnosis and procedure codes. We described prehospital characteristics and identified which factors were associated with prehospital cardiac arrest and which factors were associated with in-hospital mortality.RESULTSOf 68 890 pediatric encounters, 13 732 (19.9%) involved CMC, most commonly owing to neuromuscular conditions (29.7%). Among EMS encounters for CMC, 33.0% resulted in hospital admission, and 7.2% required critical care. Prehospital cardiac arrest occurred in 1.0% of cases, and in-hospital mortality was 0.7%. Among CMC, the presence of prehospital cardiac arrest was associated with cardiovascular (odds ratio [OR] 3.10, 95% CI: 2.08-4.62), neuromuscular (OR 2.71, 95% CI: 1.82-4.03), and neonatal (OR 2.71, 95% CI: 1.65-4.44) conditions. The presence of medical complexity was associated with a 9.55-times higher odds of in-hospital mortality (95% CI: 6.01-15.18).CONCLUSIONSCMC account for one-fifth of EMS of pediatric encounters transported to the hospital. Our findings support targeted EMS training, technology-specific protocols, and integrated prehospital-hospital data systems to improve the safety and outcomes of CMC.
{"title":"Use of Emergency Medical Services for Children With Medical Complexity.","authors":"Sriram Ramgopal,Carolyn Foster,Michelle L Macy,Christopher M Horvat,Rebecca E Cash,Julia A Heneghan,Allan M Joseph,Stephen Janofsky,Christian Martin-Gill","doi":"10.1542/peds.2025-074802","DOIUrl":"https://doi.org/10.1542/peds.2025-074802","url":null,"abstract":"OBJECTIVEThe care of children with medical complexity (CMC) in the prehospital setting is recognized as a priority in consensus-based Emergency Medical Services (EMS) guidelines. We examined EMS use, care patterns, and outcomes for CMC, including cardiac arrest and mortality.METHODSWe performed a multi-EMS agency and multicenter study of pediatric transports, from the scene to the hospital, to 1 of 17 hospitals within an integrated health system. We identified CMC based on encounter-level diagnosis and procedure codes. We described prehospital characteristics and identified which factors were associated with prehospital cardiac arrest and which factors were associated with in-hospital mortality.RESULTSOf 68 890 pediatric encounters, 13 732 (19.9%) involved CMC, most commonly owing to neuromuscular conditions (29.7%). Among EMS encounters for CMC, 33.0% resulted in hospital admission, and 7.2% required critical care. Prehospital cardiac arrest occurred in 1.0% of cases, and in-hospital mortality was 0.7%. Among CMC, the presence of prehospital cardiac arrest was associated with cardiovascular (odds ratio [OR] 3.10, 95% CI: 2.08-4.62), neuromuscular (OR 2.71, 95% CI: 1.82-4.03), and neonatal (OR 2.71, 95% CI: 1.65-4.44) conditions. The presence of medical complexity was associated with a 9.55-times higher odds of in-hospital mortality (95% CI: 6.01-15.18).CONCLUSIONSCMC account for one-fifth of EMS of pediatric encounters transported to the hospital. Our findings support targeted EMS training, technology-specific protocols, and integrated prehospital-hospital data systems to improve the safety and outcomes of CMC.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502174","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}
BACKGROUND AND OBJECTIVESSuicidal ideation (SI) significantly increases during the transition from childhood to adolescence, serving as a key predictor of future suicidal behaviors. Despite this, research focusing on preadolescents is scarce and often overlooks immediate risk factors, which hampers the predictive accuracy regarding future suicidality. We examine the dynamic impact of late childhood factors on SI during the transition to early adolescence.METHODSThis study used data from the Adolescent Brain Cognitive Development study. SI was assessed via the Kiddie Schedule for Affective Disorders and Schizophrenia semistructured interview, while factors were evaluated across demographic, psychological, cognitive, and environmental domains. An improved random forest algorithm was employed for predictive modeling and feature selection, ensuring a robust analysis of contributing factors.RESULTSThe study included 9743 unrelated children, with female children accounting for 47.4%. Psychopathology was the most significant contributor to both newly onset (weight = 27.2%) and recurrent SI (35.0%), maintaining a stable impact throughout follow-up (27.7% to 29.9%). The influence of impulsive traits (16.4% to 19.5%) and cognitive functioning (12.6% to 19.5%) increased over time, emphasizing their dynamic role. The impact of the childhood rearing environment diminished (19.1% to 10.1%) but remained critical for the incidence of SI (26.1%).CONCLUSIONSThese findings highlight the importance of understanding the dynamic influences of late childhood factors to inform early identification and intervention strategies aimed at preventing SI during this pivotal transition.
{"title":"Childhood Risk Factors for Preadolescent Suicidal Ideation.","authors":"Xiaoxia Duan,Yujie Tao,Shu Zhao,Xinyi Yu,Junfeng Wang,Yi Huang","doi":"10.1542/peds.2025-071631","DOIUrl":"https://doi.org/10.1542/peds.2025-071631","url":null,"abstract":"BACKGROUND AND OBJECTIVESSuicidal ideation (SI) significantly increases during the transition from childhood to adolescence, serving as a key predictor of future suicidal behaviors. Despite this, research focusing on preadolescents is scarce and often overlooks immediate risk factors, which hampers the predictive accuracy regarding future suicidality. We examine the dynamic impact of late childhood factors on SI during the transition to early adolescence.METHODSThis study used data from the Adolescent Brain Cognitive Development study. SI was assessed via the Kiddie Schedule for Affective Disorders and Schizophrenia semistructured interview, while factors were evaluated across demographic, psychological, cognitive, and environmental domains. An improved random forest algorithm was employed for predictive modeling and feature selection, ensuring a robust analysis of contributing factors.RESULTSThe study included 9743 unrelated children, with female children accounting for 47.4%. Psychopathology was the most significant contributor to both newly onset (weight = 27.2%) and recurrent SI (35.0%), maintaining a stable impact throughout follow-up (27.7% to 29.9%). The influence of impulsive traits (16.4% to 19.5%) and cognitive functioning (12.6% to 19.5%) increased over time, emphasizing their dynamic role. The impact of the childhood rearing environment diminished (19.1% to 10.1%) but remained critical for the incidence of SI (26.1%).CONCLUSIONSThese findings highlight the importance of understanding the dynamic influences of late childhood factors to inform early identification and intervention strategies aimed at preventing SI during this pivotal transition.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"57 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495016","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 : 2026-03-23DOI: 10.1542/peds.2026-076118
Deena R Levine,Naomi T Laventhal,Robert Macauley,
Although consensus on medical treatment for critically ill children is ideally achieved through shared decision making, disagreements on the appropriate course of action can occur. This clinical report provides practical guidance for pediatricians and other physicians in navigating and resolving disputes when parents (or other appropriate surrogate decision makers for children) request interventions that are not medically recommended and are determined to be "potentially nonbeneficial." Although this can occur over a range of medical contexts, this statement focuses on life-threatening situations. This statement provides ethical background in a historical context, offers a basic framework for approaching disagreements about provision and continuation of life-sustaining interventions, and offers a stepwise approach to preventing intractable disputes. This process includes working to form a goal-concordant treatment plan and systematically responding to parental requests for potentially nonbeneficial treatment by way of diligent information gathering, mobilization of institutional resources, and providing families with options for transfer and appeal. This clinical report is supported by an accompanying technical report of the same title.
{"title":"Responding to Parental Requests for Potentially Nonbeneficial Treatment in Life-Threatening Situations: Clinical Report.","authors":"Deena R Levine,Naomi T Laventhal,Robert Macauley, ","doi":"10.1542/peds.2026-076118","DOIUrl":"https://doi.org/10.1542/peds.2026-076118","url":null,"abstract":"Although consensus on medical treatment for critically ill children is ideally achieved through shared decision making, disagreements on the appropriate course of action can occur. This clinical report provides practical guidance for pediatricians and other physicians in navigating and resolving disputes when parents (or other appropriate surrogate decision makers for children) request interventions that are not medically recommended and are determined to be \"potentially nonbeneficial.\" Although this can occur over a range of medical contexts, this statement focuses on life-threatening situations. This statement provides ethical background in a historical context, offers a basic framework for approaching disagreements about provision and continuation of life-sustaining interventions, and offers a stepwise approach to preventing intractable disputes. This process includes working to form a goal-concordant treatment plan and systematically responding to parental requests for potentially nonbeneficial treatment by way of diligent information gathering, mobilization of institutional resources, and providing families with options for transfer and appeal. This clinical report is supported by an accompanying technical report of the same title.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495017","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 : 2026-03-23DOI: 10.1542/peds.2026-076119
Deena R Levine,Naomi T Laventhal,Robert Macauley,
Although consensus on a medical treatment plan is ideally achieved through a process of shared decision making, disagreements about whether life-sustaining interventions should be initiated or continued can occur and are sometimes difficult to resolve. When parents (or other appropriate surrogate decision makers) desire treatments for their child that are not medically recommended, these "potentially nonbeneficial" interventions must be systematically considered in the context of contemporary ethical principles and relevant laws and regulations while keeping in mind the historical and cultural underpinnings that might be playing a role, the potential for racial bias and socioeconomic disparities, the role of spirituality and values in consideration of quality-of-life determinations and end-of-life care, and the nuance of probabilistic uncertainty. This technical report accompanies a clinical report of the same name and offers a stepwise approach for responding to parental requests for potentially nonbeneficial treatment to support pediatricians and other physicians in engaging and supporting patients, their families, and care teams in navigating these disagreements.
{"title":"Responding to Parental Requests for Potentially Nonbeneficial Treatment in Life-Threatening Situations: Technical Report.","authors":"Deena R Levine,Naomi T Laventhal,Robert Macauley, ","doi":"10.1542/peds.2026-076119","DOIUrl":"https://doi.org/10.1542/peds.2026-076119","url":null,"abstract":"Although consensus on a medical treatment plan is ideally achieved through a process of shared decision making, disagreements about whether life-sustaining interventions should be initiated or continued can occur and are sometimes difficult to resolve. When parents (or other appropriate surrogate decision makers) desire treatments for their child that are not medically recommended, these \"potentially nonbeneficial\" interventions must be systematically considered in the context of contemporary ethical principles and relevant laws and regulations while keeping in mind the historical and cultural underpinnings that might be playing a role, the potential for racial bias and socioeconomic disparities, the role of spirituality and values in consideration of quality-of-life determinations and end-of-life care, and the nuance of probabilistic uncertainty. This technical report accompanies a clinical report of the same name and offers a stepwise approach for responding to parental requests for potentially nonbeneficial treatment to support pediatricians and other physicians in engaging and supporting patients, their families, and care teams in navigating these disagreements.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"82 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495015","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 : 2026-03-20DOI: 10.1542/peds.2025-073661
Helena N Eide,Siri E Håberg,Øyvind E Næss,Olof Stephansson,Maria C Magnus
OBJECTIVETo examine associations between COVID-19 vaccination during pregnancy and the risk of various infections in early childhood.METHODSWe conducted a nationwide, register-based cohort study comprising all live-born infants in Norway between March 2021 and December 2023 with follow-up through 2023. We used Cox regression to estimate hazard ratios for infections diagnosed in primary or specialist health care. Separate analyses were performed for specific infections, including COVID-19.RESULTSAmong 146 031 infants born in Norway in the study period, 37 013 (25%) were exposed to COVID-19 vaccination in pregnancy. There was no difference in the overall risk of any infection registered in specialist care among offspring exposed to maternal vaccination (adjusted hazard ratio [HR], 0.99; 95% CI, 0.95-1.03). A slightly increased risk of being registered with any infection in primary care was observed among exposed offspring (adjusted HR, 1.05; 95% CI, 1.03-1.07), which was fully attenuated after excluding children of mothers who remained unvaccinated at the end of follow-up. The offspring's protection against COVID-19 decreased over time, and the adjusted HRs for hospital contact were 0.48 for the first 2 months (95% CI, 0.40-0.56), 0.76 at 3 to 5 months (95% CI, 0.60-0.98), 1.13 at 6 to 11 months (95% CI, 0.82-1.56), and 1.14 after 12 months (95% CI, 0.72-1.79). No notable difference in the risk of hospital contacts for infections other than COVID-19 was observed.CONCLUSIONCOVID-19 vaccination during pregnancy protects the offspring against hospital contact for COVID-19 during the first 6 months of life. No apparent effect was observed for other infections.
{"title":"COVID-19 mRNA Vaccination in Pregnancy and Risk of Infection in Early Childhood.","authors":"Helena N Eide,Siri E Håberg,Øyvind E Næss,Olof Stephansson,Maria C Magnus","doi":"10.1542/peds.2025-073661","DOIUrl":"https://doi.org/10.1542/peds.2025-073661","url":null,"abstract":"OBJECTIVETo examine associations between COVID-19 vaccination during pregnancy and the risk of various infections in early childhood.METHODSWe conducted a nationwide, register-based cohort study comprising all live-born infants in Norway between March 2021 and December 2023 with follow-up through 2023. We used Cox regression to estimate hazard ratios for infections diagnosed in primary or specialist health care. Separate analyses were performed for specific infections, including COVID-19.RESULTSAmong 146 031 infants born in Norway in the study period, 37 013 (25%) were exposed to COVID-19 vaccination in pregnancy. There was no difference in the overall risk of any infection registered in specialist care among offspring exposed to maternal vaccination (adjusted hazard ratio [HR], 0.99; 95% CI, 0.95-1.03). A slightly increased risk of being registered with any infection in primary care was observed among exposed offspring (adjusted HR, 1.05; 95% CI, 1.03-1.07), which was fully attenuated after excluding children of mothers who remained unvaccinated at the end of follow-up. The offspring's protection against COVID-19 decreased over time, and the adjusted HRs for hospital contact were 0.48 for the first 2 months (95% CI, 0.40-0.56), 0.76 at 3 to 5 months (95% CI, 0.60-0.98), 1.13 at 6 to 11 months (95% CI, 0.82-1.56), and 1.14 after 12 months (95% CI, 0.72-1.79). No notable difference in the risk of hospital contacts for infections other than COVID-19 was observed.CONCLUSIONCOVID-19 vaccination during pregnancy protects the offspring against hospital contact for COVID-19 during the first 6 months of life. No apparent effect was observed for other infections.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"11 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483464","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 : 2026-03-19DOI: 10.1542/peds.2025-072504
Richard D Stevenson,Mark R Conaway,Gordon Worley,Virginia A Stallings
OBJECTIVEThe California-based cerebral palsy (CP) growth charts, published in Pediatrics in 2011, demonstrated a link between Gross Motor Function Classification System (GMFCS)-stratified weight percentile (GWt%-ile) and mortality, but use has been limited. This secondary analysis from the North American Growth in Cerebral Palsy Project (NAGCPP) aims to evaluate the charts and the link between GWt%-ile and additional health markers.PATIENTS AND METHODSNAGCPP included weight and triceps skinfold thickness (TSF) in 197 boys and 146 girls, aged 2 to 18 years, GMFCS levels III through V, with CP. Health care utilization and social participation were assessed by questionnaire. GWt%-ile was determined from sex and GMFCS-specific weight charts. Using the 20th GWt%-ile cutoff previously associated with mortality risk over 3 years, we assessed the relationship with health care utilization and social participation with and without TSF and medical comorbidities.RESULTSNAGCPP weight data fit the CP charts (goodness-of-fit P = .14 for boys; P > .25 for girls). Adjusting for sex and GMFCS, children below the 20th GWt%-ile reported 5.7 times (95% CI, 2.2-14.8) more hospital stays (P < .001), 3.1 times (95% CI, 1.3-7.4) more missed regular programs (P < .001), and 2.8 times (95% CI, 1.2-6.5) more total days (P = .02) the family or child missed regular activities. TSF (fat stores) and severe feeding problems were associated independently with health and participation.CONCLUSIONThis study validates the CP growth charts and documents an association between GWt%-ile and markers of health and participation other than mortality. CP growth charts warrant consideration for clinical decision-making and research.
{"title":"Growth of Children With Cerebral Palsy and Health Outcomes.","authors":"Richard D Stevenson,Mark R Conaway,Gordon Worley,Virginia A Stallings","doi":"10.1542/peds.2025-072504","DOIUrl":"https://doi.org/10.1542/peds.2025-072504","url":null,"abstract":"OBJECTIVEThe California-based cerebral palsy (CP) growth charts, published in Pediatrics in 2011, demonstrated a link between Gross Motor Function Classification System (GMFCS)-stratified weight percentile (GWt%-ile) and mortality, but use has been limited. This secondary analysis from the North American Growth in Cerebral Palsy Project (NAGCPP) aims to evaluate the charts and the link between GWt%-ile and additional health markers.PATIENTS AND METHODSNAGCPP included weight and triceps skinfold thickness (TSF) in 197 boys and 146 girls, aged 2 to 18 years, GMFCS levels III through V, with CP. Health care utilization and social participation were assessed by questionnaire. GWt%-ile was determined from sex and GMFCS-specific weight charts. Using the 20th GWt%-ile cutoff previously associated with mortality risk over 3 years, we assessed the relationship with health care utilization and social participation with and without TSF and medical comorbidities.RESULTSNAGCPP weight data fit the CP charts (goodness-of-fit P = .14 for boys; P > .25 for girls). Adjusting for sex and GMFCS, children below the 20th GWt%-ile reported 5.7 times (95% CI, 2.2-14.8) more hospital stays (P < .001), 3.1 times (95% CI, 1.3-7.4) more missed regular programs (P < .001), and 2.8 times (95% CI, 1.2-6.5) more total days (P = .02) the family or child missed regular activities. TSF (fat stores) and severe feeding problems were associated independently with health and participation.CONCLUSIONThis study validates the CP growth charts and documents an association between GWt%-ile and markers of health and participation other than mortality. CP growth charts warrant consideration for clinical decision-making and research.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"12 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478774","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 : 2026-03-19DOI: 10.1542/peds.2025-074191
Katherin E Portwood,Bhooma Aravamuthan
{"title":"Weight and Health Outcomes in Cerebral Palsy: A Causality Dilemma.","authors":"Katherin E Portwood,Bhooma Aravamuthan","doi":"10.1542/peds.2025-074191","DOIUrl":"https://doi.org/10.1542/peds.2025-074191","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478772","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}
We report 4 children (aged 3-9 years) with severe pulmonary hypertension (PH) associated with vitamin C deficiency. All presented with either musculoskeletal symptoms or cardiorespiratory deterioration with peripheral edema. Multiple nutritional deficiencies were identified in all children, and 2 had autistic spectrum disorder. Initial echocardiography results demonstrated severe PH with right ventricular dysfunction and significantly elevated N-terminal pro-B-type natriuretic peptide levels. In 2 patients presenting with musculoskeletal symptoms, specialist radiologic review revealed subtle features of scurvy that provided early diagnostic clues before laboratory confirmation. Vitamin C levels were undetectable where samples were processed prior to replacement, highlighting the importance of securing viable samples before treatment initiation for diagnostic certainty. All children received vitamin C replacement therapy, with 3 also receiving concurrent sildenafil. Remarkably, all demonstrated rapid clinical and echocardiographic improvement following vitamin C initiation, with complete resolution within 3 months. Importantly, 1 child receiving sildenafil alone showed no therapeutic response until vitamin C was added, indicating that improvement requires correction of the underlying deficiency rather than pulmonary vasodilation alone. This case series demonstrates rapid reversibility of vitamin C deficiency-associated PH and emphasizes the importance of considering this diagnosis in children with restricted diets and unexplained PH.
{"title":"Pulmonary Hypertension Associated With Vitamin C Deficiency Is Rapidly Reversible.","authors":"Tomás Woodgate,Jay Patel,Thomas Day,Brodie Knight,Adriani Spanaki,Alistair Calder,Shahin Moledina,Sadia Quyam","doi":"10.1542/peds.2025-073645","DOIUrl":"https://doi.org/10.1542/peds.2025-073645","url":null,"abstract":"We report 4 children (aged 3-9 years) with severe pulmonary hypertension (PH) associated with vitamin C deficiency. All presented with either musculoskeletal symptoms or cardiorespiratory deterioration with peripheral edema. Multiple nutritional deficiencies were identified in all children, and 2 had autistic spectrum disorder. Initial echocardiography results demonstrated severe PH with right ventricular dysfunction and significantly elevated N-terminal pro-B-type natriuretic peptide levels. In 2 patients presenting with musculoskeletal symptoms, specialist radiologic review revealed subtle features of scurvy that provided early diagnostic clues before laboratory confirmation. Vitamin C levels were undetectable where samples were processed prior to replacement, highlighting the importance of securing viable samples before treatment initiation for diagnostic certainty. All children received vitamin C replacement therapy, with 3 also receiving concurrent sildenafil. Remarkably, all demonstrated rapid clinical and echocardiographic improvement following vitamin C initiation, with complete resolution within 3 months. Importantly, 1 child receiving sildenafil alone showed no therapeutic response until vitamin C was added, indicating that improvement requires correction of the underlying deficiency rather than pulmonary vasodilation alone. This case series demonstrates rapid reversibility of vitamin C deficiency-associated PH and emphasizes the importance of considering this diagnosis in children with restricted diets and unexplained PH.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465490","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 : 2026-03-17DOI: 10.1542/peds.2025-073934
Brian P Jenssen,Abra M Jeffers,Emara Nabi-Burza,Janani Ramachandran,Jeritt Thayer,Bethany Hipple Walters,Douglas E Levy,Robert W Grundmeier,Olivier Drouin,Mark Vangel,Nancy A Rigotti,Tyra Bryant-Stephens,Alexander G Fiks,Jonathan P Winickoff
BACKGROUNDParental smoking is a leading source of secondhand smoke exposure for children, increasing risks of respiratory illness and future smoking. Cessation treatment delivery for parents remains rare in pediatrics. This study evaluates the population-level impact of an automated tobacco treatment system integrated into the electronic health record (EHR) in pediatric primary care.METHODSWe conducted a retrospective observational study of parents whose children received care at 12 pediatric practices in a cluster-randomized trial (June 2021-August 2024). Six practices implemented an automated EHR-linked parent tobacco treatment system (screening, motivational messaging, automatic treatment connection including nicotine replacement therapy, SmokefreeTXT, and quitline referral through a previsit questionnaire); 6 implemented screening only. This analysis included all parents who completed questionnaires during routine care, excluding parents enrolled in the trial. We analyzed self-reported cessation rates among parents who reported smoking during the study period.RESULTSAmong 55 567 parents with follow-up data (49 595 mothers; 5972 fathers), smoking rates were 4.3% vs 5.5% for mothers and 6.5% vs 8.3% for fathers receiving care with vs without the system. Among mothers who reported smoking during the study, cessation rates were significantly higher for those receiving care with the system (37.4% vs 33.5%, P = .044), representing a 3.9% improvement. Among fathers who smoked, there was no difference in cessation rates (29.6% vs 29.6%).CONCLUSIONSAn automated tobacco treatment system was associated with significantly increased maternal smoking cessation in pediatric settings while showing no effect for fathers. This scalable approach could enhance pediatric preventive care by reducing household tobacco use.
背景父母吸烟是儿童接触二手烟的主要来源，增加了呼吸系统疾病和未来吸烟的风险。在儿科，为父母提供戒烟治疗仍然很少见。本研究评估了在儿科初级保健中集成电子健康记录（EHR）的自动化烟草治疗系统对人群水平的影响。方法：在一项集群随机试验中（2021年6月至2024年8月），对在12家儿科诊所接受治疗的儿童家长进行回顾性观察研究。6项实践实施了与电子病历相关的自动父母烟草治疗系统（筛查、激励信息、包括尼古丁替代疗法在内的自动治疗连接、无烟xt和通过预诊问卷转诊戒烟热线）；6只实行筛选。该分析包括所有在常规护理期间完成问卷调查的父母，不包括参加试验的父母。我们分析了在研究期间报告吸烟的父母自我报告的戒烟率。结果55567名有随访数据的家长中（母亲49 595名，父亲5972名），母亲的吸烟率分别为4.3%和5.5%，父亲的吸烟率分别为6.5%和8.3%。在研究期间报告吸烟的母亲中，接受该系统护理的母亲的戒烟率明显更高(37.4% vs 33.5%, P =。044)，增长3.9%。在吸烟的父亲中，戒烟率没有差异（29.6% vs 29.6%）。结论自动化烟草治疗系统可显著提高儿科产妇的戒烟率，而对父亲没有效果。这种可扩展的方法可以通过减少家庭烟草使用来加强儿科预防保健。
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