Pub Date : 2024-10-24DOI: 10.1542/peds.2023-065290
Celeste Hall,Alison M Friedmann,Anna Handorf,Patrick J Lenehan,Pallavi Sagar,Hannah Bank,Clement D Lee
A 6-week-old boy is brought to the hospital for fussiness and abdominal distension. He was febrile on presentation and was admitted to the hospital for further evaluation. On subsequent examinations, he continued to demonstrate abdominal distension and tenderness to palpation. Ultrasonography of the abdomen was performed and revealed a heterogeneous liver mass. With further diagnostics, a diagnosis was made and treatment initiated, with the infant experiencing resolution of his symptoms. Our panel of experts first discuss the management of an infant with abdominal distension, then discuss the evaluation of a liver mass in an infant, including oncologic, vascular, and infectious etiologies.
{"title":"A 6-Week-Old Boy With Irritability and Abdominal Distension.","authors":"Celeste Hall,Alison M Friedmann,Anna Handorf,Patrick J Lenehan,Pallavi Sagar,Hannah Bank,Clement D Lee","doi":"10.1542/peds.2023-065290","DOIUrl":"https://doi.org/10.1542/peds.2023-065290","url":null,"abstract":"A 6-week-old boy is brought to the hospital for fussiness and abdominal distension. He was febrile on presentation and was admitted to the hospital for further evaluation. On subsequent examinations, he continued to demonstrate abdominal distension and tenderness to palpation. Ultrasonography of the abdomen was performed and revealed a heterogeneous liver mass. With further diagnostics, a diagnosis was made and treatment initiated, with the infant experiencing resolution of his symptoms. Our panel of experts first discuss the management of an infant with abdominal distension, then discuss the evaluation of a liver mass in an infant, including oncologic, vascular, and infectious etiologies.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"97 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489798","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 : 2024-10-23DOI: 10.1542/peds.2024-066729
Nada Darwish,Jaimie E Wardinger,Tammy Corr
Infantile botulism is a potentially life-threatening neuromuscular disorder. It presents with descending paralysis that can involve the diaphragm and cause respiratory failure. Neurally adjusted ventilatory assist (NAVA) provides synchronized bilevel positive pressure by using electrical diaphragmatic (Edi) signals. Diaphragmatic paresis is thought to be a contraindication for using NAVA. However, the use of a NAVA catheter allows continuous assessment of diaphragm activity in infantile botulism. We discuss a case of infantile botulism in an infant from central Pennsylvania who presented with poor oral feeding, hypothermia, and lethargy and progressed to develop apnea and acute respiratory failure. The infant was intubated and mechanically ventilated. A diagnosis of infantile botulism was confirmed through the detection of botulinum toxin in the infant's stool, and the infant was treated with botulism immune globulin neutralizing antibodies. During his recovery phase, a NAVA catheter was placed, which allowed monitoring of Edi signals to gauge the return of diaphragm activity and to assist with the assessment of extubation readiness. We describe the trends in this infant's Edi signals following administration of globulin neutralizing antibodies and the successful transition to invasive, and subsequently, noninvasive NAVA. Our report demonstrates the clinical utility of monitoring diaphragmatic activity using a NAVA catheter and that NAVA provided adequate respiratory support to an infant during the recovery phase of infantile botulism.
婴儿肉毒中毒是一种可能危及生命的神经肌肉疾病。它表现为下行性麻痹，可累及膈肌并导致呼吸衰竭。神经调节通气辅助系统（NAVA）通过使用膈肌电（Edi）信号提供同步双水平正压。膈肌麻痹被认为是使用 NAVA 的禁忌症。然而，使用 NAVA 导管可以持续评估婴儿肉毒中毒患者的膈肌活动。我们讨论了一例来自宾夕法尼亚州中部的婴儿肉毒中毒病例，该婴儿表现为口服喂养不良、体温过低和嗜睡，随后发展为呼吸暂停和急性呼吸衰竭。该婴儿接受了插管和机械通气治疗。通过检测婴儿粪便中的肉毒杆菌毒素，确诊为婴儿肉毒中毒，婴儿接受了肉毒杆菌免疫球蛋白中和抗体治疗。在他的恢复阶段，我们为他置入了 NAVA 导管，通过监测 Edi 信号来判断膈肌活动的恢复情况，并协助评估拔管准备情况。我们描述了该婴儿在使用球蛋白中和抗体后的 Edi 信号趋势，以及成功过渡到有创和随后的无创 NAVA 的过程。我们的报告证明了使用 NAVA 导管监测膈肌活动的临床实用性，以及 NAVA 在婴儿肉毒中毒恢复阶段为婴儿提供了充分的呼吸支持。
{"title":"Neurally Adjusted Ventilatory Assist to Monitor Diaphragmatic Activity in Infantile Botulism.","authors":"Nada Darwish,Jaimie E Wardinger,Tammy Corr","doi":"10.1542/peds.2024-066729","DOIUrl":"https://doi.org/10.1542/peds.2024-066729","url":null,"abstract":"Infantile botulism is a potentially life-threatening neuromuscular disorder. It presents with descending paralysis that can involve the diaphragm and cause respiratory failure. Neurally adjusted ventilatory assist (NAVA) provides synchronized bilevel positive pressure by using electrical diaphragmatic (Edi) signals. Diaphragmatic paresis is thought to be a contraindication for using NAVA. However, the use of a NAVA catheter allows continuous assessment of diaphragm activity in infantile botulism. We discuss a case of infantile botulism in an infant from central Pennsylvania who presented with poor oral feeding, hypothermia, and lethargy and progressed to develop apnea and acute respiratory failure. The infant was intubated and mechanically ventilated. A diagnosis of infantile botulism was confirmed through the detection of botulinum toxin in the infant's stool, and the infant was treated with botulism immune globulin neutralizing antibodies. During his recovery phase, a NAVA catheter was placed, which allowed monitoring of Edi signals to gauge the return of diaphragm activity and to assist with the assessment of extubation readiness. We describe the trends in this infant's Edi signals following administration of globulin neutralizing antibodies and the successful transition to invasive, and subsequently, noninvasive NAVA. Our report demonstrates the clinical utility of monitoring diaphragmatic activity using a NAVA catheter and that NAVA provided adequate respiratory support to an infant during the recovery phase of infantile botulism.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488193","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 : 2024-10-23DOI: 10.1542/peds.2024-068085
Benard P Dreyer
{"title":"The 2024 Joseph W. St. Geme, Jr Leadership Award Address: To Create a Better World for Children and Families.","authors":"Benard P Dreyer","doi":"10.1542/peds.2024-068085","DOIUrl":"https://doi.org/10.1542/peds.2024-068085","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"89 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488192","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 : 2024-10-21DOI: 10.1542/peds.2024-065750
Else Foverskov,Justin S White,Trine Frøslev,Lars Pedersen,Henrik T Sørensen,Rita Hamad
OBJECTIVETo examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment.METHODSThis register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement.RESULTSEach SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations.CONCLUSIONSResettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation.
{"title":"Neighborhood Disadvantage and Birth Outcomes Among Refugees.","authors":"Else Foverskov,Justin S White,Trine Frøslev,Lars Pedersen,Henrik T Sørensen,Rita Hamad","doi":"10.1542/peds.2024-065750","DOIUrl":"https://doi.org/10.1542/peds.2024-065750","url":null,"abstract":"OBJECTIVETo examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment.METHODSThis register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement.RESULTSEach SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations.CONCLUSIONSResettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486364","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 : 2024-10-21DOI: 10.1542/peds.2024-067543
Joshua Rothman,Cara Texler,Janine Young
{"title":"Lessons Learned About Safety Nets for Refugee Arrivals and Health Outcomes.","authors":"Joshua Rothman,Cara Texler,Janine Young","doi":"10.1542/peds.2024-067543","DOIUrl":"https://doi.org/10.1542/peds.2024-067543","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"2 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486378","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 : 2024-10-21DOI: 10.1542/peds.2024-068955
Gina M Geis,Barbara S Saunders,Paula Hillard,,
There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population.
{"title":"Examining Permanent Contraception for Children, Adolescents, and Young Adults With Intellectual Developmental Disorder: Ethical, Legal, and Medical Considerations: Clinical Report.","authors":"Gina M Geis,Barbara S Saunders,Paula Hillard,,","doi":"10.1542/peds.2024-068955","DOIUrl":"https://doi.org/10.1542/peds.2024-068955","url":null,"abstract":"There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"67 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486367","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 : 2024-10-21DOI: 10.1542/peds.2024-068956
Greg Canty,Jennifer King,
Participation in cheerleading has continued to increase over the last decade, and the sport has evolved to require a higher level of athleticism. More than 3.5 million youth currently participate, with the vast majority being females between the ages of 6 and 17 years. Cheer occurs in both scholastic and nonscholastic settings; participants may perform to support other interscholastic teams or engage in competitions to showcase their skills against other squads. With the increased athletic demands of the sport and the year-round nature of competition, the number of injuries, including concussions, has risen. The overall injury rate for cheer is fairly low, but average time away from sport after injury is lengthy suggesting injuries can be severe. This policy statement reviews the epidemiology of cheerleading injuries and offers recommendations on how to improve the safety of cheerleading for all youth.
{"title":"Safety in Cheerleading: Epidemiology and Recommendations: Policy Statement.","authors":"Greg Canty,Jennifer King,","doi":"10.1542/peds.2024-068956","DOIUrl":"https://doi.org/10.1542/peds.2024-068956","url":null,"abstract":"Participation in cheerleading has continued to increase over the last decade, and the sport has evolved to require a higher level of athleticism. More than 3.5 million youth currently participate, with the vast majority being females between the ages of 6 and 17 years. Cheer occurs in both scholastic and nonscholastic settings; participants may perform to support other interscholastic teams or engage in competitions to showcase their skills against other squads. With the increased athletic demands of the sport and the year-round nature of competition, the number of injuries, including concussions, has risen. The overall injury rate for cheer is fairly low, but average time away from sport after injury is lengthy suggesting injuries can be severe. This policy statement reviews the epidemiology of cheerleading injuries and offers recommendations on how to improve the safety of cheerleading for all youth.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"33 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486365","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 : 2024-10-18DOI: 10.1542/peds.2023-064838
Charles V Golden,Raymen R Assaf,Ricardo Aguilar,Tatiana Moreno,Heather Huszti,Michelle Fortier,Theodore Heyming,Uma Rao,Louis Ehwerhemuepha,Michael Weiss
OBJECTIVESTo assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age.METHODSIn this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening.RESULTSAmong 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age.CONCLUSIONSThe association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.
{"title":"Age, Adverse Childhood Experiences, and Health Care Utilization.","authors":"Charles V Golden,Raymen R Assaf,Ricardo Aguilar,Tatiana Moreno,Heather Huszti,Michelle Fortier,Theodore Heyming,Uma Rao,Louis Ehwerhemuepha,Michael Weiss","doi":"10.1542/peds.2023-064838","DOIUrl":"https://doi.org/10.1542/peds.2023-064838","url":null,"abstract":"OBJECTIVESTo assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age.METHODSIn this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening.RESULTSAmong 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age.CONCLUSIONSThe association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"3 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449345","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 : 2024-10-17DOI: 10.1542/peds.2024-067248
Ajibike Lapite
{"title":"Cancer, Consents, and Chaos: Navigating Health Literacy at the Time of a New Oncology Diagnosis.","authors":"Ajibike Lapite","doi":"10.1542/peds.2024-067248","DOIUrl":"https://doi.org/10.1542/peds.2024-067248","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"78 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448081","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：