Pediatrics最新文献

Objective: To evaluate whether neuropsychological functioning was impaired among individuals with pediatric primary headache disorders (PHD) compared with individuals without headaches. Adults with migraine appear to evidence deficits in neuropsychological performance, but few reviews have examined whether cognitive performance is impaired among children and adolescents with primary headache disorders.

Methods: we considered studies using a validated clinical neuropsychological measure among pediatric samples (<20-y old) that included a phd and control sample. two authors independently reviewed candidate articles to determine inclusion and to extract data. data were pooled using random-effects models. data sources: pubmed, embase, proquest health & medical, proquest psychology database, and psycinfo were searched from inception to february 2024.

Results: Analysis of 16 included studies indicated significantly worse overall neuropsychological performance among pediatric PHD (g = -0.31; 95% CI = -0.44 to -0.17), as well as significantly worse performance across the motor, executive function, learning/memory, language, processing speed, intelligence, and visuospatial/construction domains, as compared with nonheadache controls. Moderate heterogeneity was observed (I2 = 43.13%) but analyses of publication bias and moderators were not significant. Sensitivity analyses indicated that negative effects were driven by samples with migraine and not observed among tension-type headache (TTH) samples.

Conclusions: Relative to controls without headache, pediatric samples with migraine demonstrate worse neurocognitive performance both generally and across specific domains. A small number of studies among samples with TTH were included and moderator analyses were likely underpowered.

Medical advancements over the last century have improved our ability to treat pediatric infectious diseases, significantly reducing associated morbidity and mortality worldwide. Although vaccines have been pivotal in this progress, many viral pathogens still do not currently have effective vaccines. The COVID-19 pandemic highlighted the need for rapid responses to emerging viral pathogens and introduced new tools to combat them. This review addresses human monoclonal antibodies (mAbs) as a strategy for treating and preventing viral infections in pediatric populations. We discuss previously used and currently available mAbs and advancements in mAb discovery. We address the future of mAb therapy by describing novel approaches in drug production and delivery platforms in addition to alternative antibody classes. Finally, we review the challenges and limitations of mAb therapy development for newborns and children.

Encephalopathy is a disturbance in neurologic function. It is commonly attributed to infectious and inflammatory etiologies but encompasses a wide differential. Hypereosinophilic syndrome (HES) is a rare cause of encephalopathy that is associated with underlying infection or malignancy. We present a pediatric patient who experienced several days of worsening encephalopathy and neurological deterioration associated with influenza B infection and hypereosinophilia. A thorough workup ultimately revealed a diagnosis of HES secondary to B cell acute lymphoblastic leukemia (B-ALL). This case exemplifies the importance of maintaining a broad approach to the diagnostic evaluation, treatment, and management of encephalopathy.

Background and objectives: Agenesis of the corpus callosum (ACC) is a common congenital brain malformation. Early development in ACC remains unexamined, despite the increased likelihood for developmental delays and autistic behaviors. This study compares adaptive functioning in infants/toddlers with isolated ACC to children with other neurodevelopmental conditions and typical development.

Methods: Parents of children with ACC completed the Vineland Adaptive Behavior Scale Interview at 6, 12, 18, and 24 months as part of a prospective longitudinal study. Comparison groups included children with fragile X, Down syndrome, high familial likelihood of autism spectrum disorder (both with and without autism spectrum diagnosis), and typical development (total n = 957; total assessments = 2676).

Results: By 24 months, 29% of children with ACC were delayed in at least 1 domain. Linear mixed effect models showed significant group × time point interactions in all domains. Post-hoc comparisons revealed the ACC group had poorer performance in communication by 6, motor by 12, and daily living by 18 months but equivalent socialization compared with typically developing children; stronger skills across most domains and time points compared with genetic groups; and equivalent communication, stronger socialization, and weaker motor skills compared with the autism group.

Conclusions: Although there is significant variability, on average, ACC compromises communication skills by 6 months, with reduced motor and daily living skills by 12 and 18 months, respectively. Multipronged intervention programs are needed for ACC beginning early in the first year of life, possibly leveraging early strengths in social skills.

Background and objectives: Nonfatal assault injuries have significant consequences for adolescent health, but trends in health care use after such injuries are poorly understood. We analyzed locations of medical care, examined temporal trends in health care and victim service use, and explored variations by injury type among adolescent violent injuries.

Methods: We analyzed the National Crime Victimization Survey (1994-2023) for injuries requiring care among adolescents aged 12 to 18 years. We estimated victimization rates and proportions of injuries receiving types of care using direct variance estimation. To identify trends in health care and victim service use, we used survey-weighted logistic regression models with year as an interval variable and specifications for quadratic relationships.

Results: Among adolescent violent injuries receiving any treatment, 44.0% (95% CI, 39.9-48.2) were treated at a hospital or clinic. From 1996 to 2021 (5-year moving averages), rates of violent injuries receiving treatment declined by 84.0%, from 14.4 (12.4-16.4) to 2.3 (1.4-3.2) per 1000 adolescents. The percentage of injuries receiving hospital or clinic care increased from 36.9% in 1996 to 59.1% in 2009 (odds ratio [OR]year = 1.119, 95% CI 1.046-1.197), then decreased to 36.1% by 2021 (ORyear2 = 0.996, 95% CI 0.993-0.999). Victim service use remained consistently lower (ORyear = 0.991, 95% CI 0.955-1.027) and fluctuated between 14.1% and 22.9%.

Conclusion: Adolescent violent injury rates significantly declined from 1994 to 2023. However, substantial proportions of injured adolescents receiving any type of care do not receive hospital-based care or victim services. Innovative approaches are needed to engage adolescent victims of violence in medical settings and improve access to support services.

West Virginia has one of the most robust childhood school-entry immunization policies in the nation, allowing only medical exemptions. As of the 2024 state legislative session, the last reported case of measles in West Virginia was in 2009. For over a decade, multiple bills have been introduced to attempt to weaken the immunization policy. In 2024, the West Virginia Legislature passed House Bill (HB) 5105, which would allow private and parochial schools in West Virginia the option to opt out of state immunization requirements. This bill would threaten the well-being and lives of West Virginians by weakening herd immunity. In response, the West Virginia chapter of the American Academy of Pediatrics banded together with multiple stakeholders to coordinate a veto campaign for HB 5105 using media, petitions, phone calls, and in-person visits. Governor Jim Justice ultimately vetoed HB 5105. This case study highlights the importance of effective collaboration with stakeholders, engagement of medical organizations with shared goals, coordinated advocacy by health care professionals, and creating and implementing an effective public health message to maintain effective public health policy.

Objective: Urine dipsticks can be performed at the point of care, whereas urinalysis requires laboratory analysis. We compared the accuracy of urine dipstick with urinalysis for the diagnosis of urinary tract infection (UTI) in febrile infants aged 2 to 6 months.

Methods: We performed a cross-sectional study of previously healthy infants aged 2 to 6 months who presented to one of 5 emergency departments with a temperature greater than or equal to 38.0 °C and had a catheterized urine culture obtained. We defined a UTI with a urine culture growing greater than or equal to 50 000 colony-forming units (CFUs) per milliliter of a single bacterial uropathogen. Using receiver operator characteristic (ROC) curve analysis to select the optimal urine white blood cell (WBC) cut point, we compared positive urine dipstick (≥1+ leukocyte esterase or positive nitrite) to dichotomized urine WBC count for the diagnosis of UTI.

Results: Of 9387 febrile infants who had a urine culture performed, 1044 (11%) had a UTI. Escherichia coli was the most common pathogen identified (923; 88.4%). The optimal urine WBC cut point was greater than or equal to 7 cells per high-power field (HPF). When compared with urine WBC count of greater than or equal to 7 cells per HPF, urine dipstick had a higher sensitivity (831/921 [90.2%] dipstick vs 738/880 [83.9%] urine WBC; difference 6.4%, 95% CI 3.8%-8.9%) and specificity (6352/6862 [92.6%] dipstick vs 3679/4231 [87.0%] urine WBC; difference 5.6%, 95% CI 4.7%-6.6%).

Conclusion: Urine dipstick is an accurate diagnostic test for UTI in febrile infants aged 2 to 6 months. Laboratory urinalysis may not be required to guide initial treatment decisions.

In the following case, we will discuss the clinical, ethical, and legal intricacies associated with the management of a young child with a hereditary cancer predisposition syndrome. Patients with germline pathogenic variants in SMARCA4 are at an increased risk for development of small cell carcinoma of the ovary-hypercalcemic type, malignant rhabdoid tumors, and some lung cancers. This case highlights the complexity of a case wherein a mother is found to have this genetic syndrome, and further testing reveals her daughter to have the same pathogenic variant. Through this case, we explore the oncologic, genetic, legal, and ethical considerations at play when making an irreversible decision for a child that affects her current and future medical and reproductive capacities. To do so would mitigate the risk of future malignancy, adding a layer of legal and ethical complexity. Although each contributor individually concludes that surgery in this case should be delayed, this case demonstrates the need for an individualized approach that considers medical evidence, patient and family interests, and child welfare.

Context: Quantifying the impact of place on pediatric health is difficult given the diverse methodologies used to measure place-based social determinants. However, the Child Opportunity Index (COI) is increasingly used to study these relationships.

Objective: To synthesize associations between the COI and pediatric health.

Data sources: Fifteen databases, 4 gray literature sources, and diversitydatakids.org searched from 2014 to 2024.

Study selection: US-based observational studies that evaluated children, the COI, and at least 1 pediatric health outcome.

Data extraction: Protocol registered with PROSPERO (CRD42023418407). Random-effects models created pooled odds ratios (ORs) comparing very low/low COI to high/very high COI for mortality, emergency department (ED) use, and hospital use. Clinically relevant subgroups were explored.

Results: Most studies (n = 61 of 85; 72%) reported inverse associations between the COI and an adverse outcome. Lower COI was associated with higher odds of mortality (OR, 1.50; 95% CI, 1.31-1.94; tau squared [τ2] = 0.045; 15 associations from 13 studies). Overall, ED visits were similar (OR, 1.38; 95% CI, 0.97-1.95; τ2 = 0.312; 10 associations from 6 studies), but the subgroup of all-cause ED visits were significantly higher among children with lower COI (OR, 1.66; 95% CI, 1.19-2.31; τ2 = 0.198; 7 associations from 5 studies). Select hospitalization subgroups (medical, surgical/trauma, and >30-day rehospitalizations) were significantly associated with COI, but not overall hospitalizations (OR, 1.15; 95% CI, 0.96-1.36; τ2 = 0.090; 12 studies).

Limitations: Meta-analyses were unadjusted.

Conclusions: Place is a risk factor for children's mortality and select measures of health care use. Shifting the focus from identifying place-based disparities to cocreating community-engaged strategies that mitigate disparities may effectively advance children's health equity.