Pediatrics最新文献

Objectives: To identify opportunities for improvement in quality of care, we explore Black families' experiences of family support in the neonatal intensive care unit (NICU) during their infant's hospital stay.

Methods: Semistructured qualitative interviews or focus groups (FGs) were conducted to explore Black families' experiences of NICU hospitalization. Inclusion criteria were self-identification as a Black family member and infant admission to our NICU between January 2020 and February 2022. We conducted reflexive thematic analysis of recorded transcripts using Dedoose software.

Results: Three interviews and 2 FGs were conducted with 9 unique families (n = 13 individuals). We organized 10 key themes into "Experiences" and "Recommendations." Experience themes included distrust and fear of the medical setting, hypervigilance and trauma trajectory formation, the myth of "Black hardiness," policing and surveillance, and undermining of Black parenting. Recommendation themes implored NICU staff to earn rather than assume trust, respect family concerns, improve mental health support, provide compassionate care, and support the parenting role.

Conclusions: In this single-center qualitative study of Black families' NICU encounters, families continue to experience differential treatment, which reinforces an untrustworthy medical system perpetuating structural racism. Family recommendations for improving care through transparent communication, advocacy and mental health support, increased engagement in their parental role, and decreasing biased treatment and provision of resources may improve their experience and mitigate hypervigilance and trajectory formation in our NICU.

Objective: Our institutional data revealed high pneumothorax rates in term neonates resuscitated in the delivery room (DR). Other studies have reported that high rates of continuous positive airway pressure (CPAP) in the DR are associated with increased pneumothorax rates. We sought to test the hypothesis that quality improvement efforts to reduce the use of CPAP in the DR would be associated with a reduced incidence of pneumothorax.

Methods: We performed a series of interventions to make minor revisions to our DR respiratory care algorithm focusing on optimizing CPAP use by providing education to the DR team to the revisions. For neonates born at 36 weeks of gestation or beyond, we evaluated the use of CPAP in the DR and the number of births between pneumothorax events before and after the algorithm was implemented. We used statistical process control charts to assess improvement.

Results: CPAP utilization in the DR for infants 36 weeks or older decreased from 3.4% to 1.0%. Frequency of pneumothorax decreased, with births between pneumothorax events increasing from 293 to 530. We found no increase in the number of neonates requiring a higher level of care with respiratory distress.

Conclusion: We found that a reduction in the use of CPAP in DR was associated with a decrease in the rate of pneumothorax without an increase in neonates requiring additional care with respiratory distress.

Background and objectives: Research on conversations between caregivers and their children about how to prepare or conduct themselves when stopped by police (ie, "the talk") has grown in recent years. However, little is known about how having "the talk" may influence youths' stress about future experiences of police brutality (ie, anticipatory stress of police brutality). The objective of the present study is to examine how youths' anticipatory stress regarding police brutality varies by whether they have had "the talk" with their caregivers.

Methods: Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a cross-sectional survey of a community-based sample of Black youth aged 12 to 21 years in Baltimore, Maryland (n = 339), collected from August 2022 to July 2023. Multivariable ordinary least squares regressions were conducted to (1) examine associations between "the talk" and anticipatory stress of police brutality among a sample of Black youth in Baltimore and (2) examine the associations between messages in "the talk" and anticipatory stress of police brutality among youth who received "the talk."

Results: Findings indicate that having "the talk" was associated with lower anticipatory stress of police brutality. Moreover, among youth who received "the talk," certain messages from parents during "the talk" were associated with significant increases in anticipatory stress of police brutality compared with other messages.

Conclusions: Findings underscore the need for a nuanced understanding of "the talk's" broader implications on youth well-being and may be used to expand opportunities for youth to encounter affirmative racial socialization messages.

Background and objectives: Preterm birth results in neonatal and childhood morbidity and mortality. Additionally, population-based studies show poorer cardiovascular health in adult survivors, but a full range of health outcomes has not been investigated into midlife. We aimed to assess the health outcomes after preterm vs term birth at 50 years in survivors of a randomized trial of antenatal betamethasone.

Methods: Participants were asked to complete a health questionnaire and for consent to access administrative data. Participants deceased prior to follow-up were assessed with administrative data alone. The primary outcome was a composite: any of diabetes mellitus, prediabetes, treated hypertension, treated dyslipidemia, or a previous major adverse cardiovascular event. Secondary outcomes included respiratory, mental health, educational, and other health outcomes.

Results: We included 470 participants: 424 assessed at mean age 49.3 years and 46 who died after infancy. The primary outcome occurred in 34.5% (112/325) of those born preterm and 29.9% (43/144) of those born at term; adjusted relative risk (aRR) 1.14 (95% CI, 0.85-1.54; P = .37). Cardiovascular events were less common in those born preterm (9/326 [2.8%] vs 10/144 [6.9%]; aRR 0.33, 95% CI, 0.14-0.79), while self-reported hypertension was more common (101/291 [34.7%] vs 23/116 [19.8%]; aRR 1.74, 95% CI, 1.16-2.61), although treated hypertension was not statistically significantly different (66/323 [20.4%] vs 22/143 [15.4%]; aRR 1.32, 95% CI, 0.84-2.06). Other components of the composite endpoint were similar between those born preterm and at term.

Conclusions: Those aged 50 years born preterm were more likely to have hypertension but had similar risk of diabetes, prediabetes, and dyslipidemia than those born at term, and their risk of cardiovascular events was lower.

Critical congenital heart disease (CCHD) screening was added to the US Recommended Uniform Screening Panel in 2011 and adopted by all US states and territories by 2018. In addition to reviewing key developments in CCHD screening since the initial American Academy of Pediatrics (AAP) endorsement in 2011, this clinical report provides 3 updated recommendations. First, a new AAP algorithm has been endorsed for use in CCHD screening. Compared with the original AAP algorithm from 2011, this new algorithm a) has a passing oxygen saturation threshold of ≥95% in both pre- and post-ductal measurements; and b) has only 1 retest instead of 2 for infants who did not pass the first screen. Second, to continue to improve screening, state newborn screening programs should collect a recommended minimum uniform dataset to aid in surveillance and monitoring of the program. Finally, stakeholders should be educated on the limitations of screening, the significance of non-CCHD conditions, and the importance of protocol adherence. Future directions of CCHD screening include improving overall sensitivity and implementing methods to reduce health inequities. It will remain critical that the AAP and its chapters and members work with health departments and hospitals to achieve awareness and implementation of these recommendations.