Pediatrics最新文献

Objective: Therapeutic hypothermia within 6 hours of birth is critical for newborns with hypoxic-ischemic encephalopathy (HIE) but is often delayed by transfers to appropriate facilities. Telemedicine (TM) based hypothermia evaluation could expedite these assessments. There is limited evidence on the efficacy of TM compared with the in-person (IP) Sarnat examination. In this study, we aim to compare the TM with the IP examination in infants with suspected HIE.

Methods: Newborns were enrolled from March 2022 to December 2023. All infants underwent IP and TM assessments using the modified Sarnat examination within 6 hours after birth. Data included neurologic examination scores for both IP and TM, decisions for hypothermia qualification, and TM technology metrics. Cohen's kappa statistic (κ) was used to measure the interrater agreement between IP and TM examination findings.

Results: 170 Sarnat assessments (IP and TM) were performed on 85 enrolled infants. The results show almost perfect agreement between IP and TM regarding signs of moderate or severe HIE (κ = 0.82) and the decision for hypothermia intervention (κ = 0.82). We report fair to moderate agreement (κ = 0.33-0.58) for individual categories of the neurologic examination. 93% of TM examinations were completed within 15 minutes, and 79% of the TM encounters had no technology issues.

Conclusions: This study compares IP and TM assessments in infants requiring hypothermia evaluation. Findings show that TM is feasible and not significantly different from IP for making hypothermia decisions in suspected HIE. This could enhance remote Sarnat evaluations and initiate earlier therapeutic interventions.

Here, we present a unique case of a 17-year-old boy who presented with progressive lower extremity weakness, functional decline, and mood changes and was ultimately found to have a new diagnosis of AIDS from perinatally acquired HIV infection. This case demonstrates the discovery of a delayed diagnosis of HIV with important lessons for all pediatricians. It highlights the need for pediatricians to maintain a high index of suspicion and consider broad differentials and appropriate workup for at-risk youth with known psychiatric conditions. It is essential to identify at-risk youth early to prevent progression and severity of illness.

Objective: Black families often address police interaction safety with a conversation known as "The Talk." Previous academic literature centering the physician's perspective has proposed pediatrician involvement in anticipatory guidance on this topic. This study explores the views of Black teenage male individuals and their caregivers on pediatricians discussing safe police interactions as part of routine guidance and seeks to identify key factors for facilitating these discussions.

Methods: Semistructured interviews were conducted individually with Black male individuals aged 13 to 18 years and their caregivers. Participants were recruited from primary care well visits at an academic institution in west Philadelphia, Pennsylvania. Interviews were conducted virtually, recorded, and transcribed for analysis. Themes were validated by randomly selected participants of the study.

Results: A total of 47 participants, including 20 youth-caregiver dyads, completed interviews. Participants supported pediatrician involvement in anticipatory guidance for teenagers about navigating police encounters, emphasizing that conversations should seek to improve youth safety and reduce fear during police encounters. Interviewees felt that racial concordance with pediatricians was not essential if the discussion was compassionate and culturally sensitive. Caregivers expressed a desire to align pediatrician guidance with family teaching and child's social and cognitive development. Participants preferred one-on-one conversations with pediatricians to enhance receptivity.

Conclusions: Black teenage male individuals and their caregivers are open to pediatricians discussing police interactions as part of anticipatory guidance, emphasizing a tailored, sensitive approach. Further research is needed to investigate the perspectives of Black non-male youth and other populations disproportionately impacted by police violence.

Background and objectives: Researchers have not yet collected sufficient prognostic data on the combined use of structural brain MRI (sMRI) with General Movements Assessment (GMA) or Hammersmith Infant Neurological Examination (HINE) in children born preterm for diagnosing cerebral palsy (CP) before 5 months corrected age (CA), particularly for Gross Motor Function Classification System (GMFCS) level I CP. We evaluated the predictive values of sMRI, GMA, and HINE individually and in combination for early CP diagnosis and assessed accuracy across varying GMFCS levels in children born preterm.

Methods: We studied a prospective regional cohort of 395 preterm infants (≤32 weeks' gestation) from 5 NICUs in Greater Cincinnati. The primary outcome was CP diagnosis at 22 to 26 months CA, classified by GMFCS. We calculated sensitivity, specificity, predictive values, and likelihood ratios for CP diagnosis/prediction for an abnormal sMRI (motor tract abnormalities) at 39-44 weeks postmenstrual age and an abnormal GMA (absent fidgety movements) or HINE (score below 56) at 12 to 18 weeks CA.

Results: Of 338 (86%) children with complete follow-up, 39 (11.5%) developed CP (28 GMFCS level I, 11 levels II-V). Combining sMRI and GMA achieved 100% specificity and 22% sensitivity, while sMRI and HINE exhibited 32% sensitivity, 98% specificity. These 2 combinations achieved higher sensitivity (78%-90%) and specificity (98%-100%) for predicting CP levels II to V.

Conclusions: In our preterm cohort, sMRI plus GMA/HINE demonstrated high specificity but low sensitivity in predicting CP, underscoring the need for longer developmental follow-up and more sensitive diagnostic tools for early detection of CP in children born preterm.

Objective: We aimed to assess whether the presence of a therapy dog during 2 dental care sessions could facilitate subsequent dog-free dental care for anxious autistic children who had difficulty cooperating.

Methods: We conducted a parallel-arm randomized trial: control group using usual behavioral strategies only and experimental group using animal-assisted therapy (AAT) strategies combined with usual behavioral strategies. All patients had 3 dental care sessions. In the experimental group, the therapy dog was present during the first 2 dental sessions, and the third dental session was dog-free. The primary outcome was the mean overall anxiety during the dog-free third treatment session. Generalized estimating equations (GEEs) were also used to account for the correlation of repeated measures.

Results: A total of 49 patients were enrolled. The most frequently usual behavioral strategies were positive reinforcement (n = 31; 64%), hypnosis (n = 28; 58%), demystification (n = 26; 52%), and in vivo modeling (n = 25; 51%). AAT-specific strategies included imitating dog (n = 18; 69%), positive supportive reinforcement with dog incentives (n = 14; 54%), and distraction or therapeutic touch (n = 11; 42%). Mean anxiety scores were significantly lower in the experimental group during the third session (mean difference, -1.4; 95% CI, -2.43 to -0.37). GEE analysis showed a significant reduction in anxiety over time in the experimental group compared with controls (P = .0001; β = -1.03).

Conclusion: Dog served mainly as an in vivo model and positive reinforcer. Our findings suggest that AAT could play a key role in helping children acclimate to dental procedures, and, consequently, ease the transition back to conventional, animal-free dental treatments.

This is a revision of the previous joint policy statement titled "Pediatric Readiness in the Emergency Department." This is a joint policy statement from the American Academy of Pediatrics, the American College of Emergency Physicians, the American College of Surgeons, and the Emergency Nurses Association. These updated recommendations are intended to serve as a resource for clinical and administrative leadership of emergency departments as they strive to improve their readiness for the emergency care of children of all ages.

Congenital diaphragmatic hernia (CDH) is a rare defect that most commonly presents in neonates with severe respiratory distress. Late presentation in older children is exceedingly rare and often accompanied by nonspecific symptoms, leading to diagnostic challenges. We report the case of a 9-year-old child who initially presented with nonspecific abdominal pain, nausea, and vomiting. Initial evaluations, including computed tomography (CT) imaging, led to the initial diagnosis of a splenule. Owing to persistent symptoms, repeated imaging 2 weeks later revealed herniation of abdominal contents into the thoracic cavity, confirming a large left-sided CDH. The patient underwent thoracoscopic surgical repair of a Bochdalek defect, leading to resolution of symptoms. This case highlights diagnostic challenges surrounding late-presenting CDH, including its variable clinical presentation ranging from nonspecific gastrointestinal or respiratory symptoms, as well as challenges of radiographic interpretation. This case emphasizes the importance of considering CDH in diagnostic workups in all age groups, even when imaging findings are inconclusive, to ensure timely and accurate diagnosis and treatment.

Objective: Children with certain underlying conditions are at higher risk for severe influenza-related complications. In the United States, annual influenza vaccination is recommended for all children aged 6 months and older, yet vaccine effectiveness (VE) in children with underlying conditions remains less understood. We assessed VE against laboratory-confirmed influenza in children with and without underlying conditions presenting to emergency departments or admitted to hospitals.

Methods: We enrolled US children aged 6 months to 17 years at 7 pediatric medical centers within the New Vaccine Surveillance Network during 5 influenza seasons (2015-2020). Influenza status was confirmed by molecular testing and vaccination status was verified using state immunization registries or from health care clinicians. Underlying conditions were abstracted from medical records or self-reported by parents/guardians. VE was estimated by comparing the odds of vaccination among influenza-positive cases vs controls, adjusting for age, site, and calendar time.

Results: Of the 15 875 children included, 2821 (18%) tested positive for influenza. Overall, VE against influenza-associated emergency department visits or hospitalizations was 43% (95% CI: 35%-50%) for children with underlying conditions and 53% (95% CI: 47%-59%) for those without, and there was significant effect measure modification by the presence of underlying conditions (P = .04). VE was lowest among children with respiratory conditions (31%, 95% CI: 19%-42%).

Conclusion: Influenza vaccination provided protection in both children with and children without underlying conditions. Efforts to improve influenza vaccination coverage and to initiate early treatment for influenza, particularly in populations at increased risk for severe influenza, are essential to reducing influenza-associated complications.

Context: Cystic fibrosis-related diabetes significantly impacts health outcomes of people with cystic fibrosis (CF). Understanding the effects of CF transmembrane conductance regulator modulator (CFTRm) therapy on glycemic control is crucial for improving overall health in CF.

Objective: To evaluate the impact of CFTRm therapy on glycemic control in people with CF.

Data sources: A comprehensive literature search was conducted from January 1, 2011, to September 19, 2024, in PubMed, Embase, and Cochrane Central Register of Controlled Trials.

Study selection: Eligible studies included interventional trials comparing CFTRm therapy to no treatment or placebo and observational studies reporting glycemic outcomes-assessed by oral glucose tolerance test or continuous glucose monitoring-pretherapy and on therapy or between treated individuals and controls.

Data extraction: Two authors independently extracted data with full adherence to the Cochrane Handbook.

Results: Elexacaftor/tezacaftor/ivacaftor therapy (ETI) significantly improved 120-minute glucose levels (mean difference, -24.30 mg/dL; 95% CI, -44.82 to -3.96) and lowered hemoglobin A1c (HbA1c) levels (mean difference, -0.44%; 95% CI, -0.75 to -0.13). Regression analyses showed that earlier ETI therapy initiation was associated with lower HbA1c values (P = .03). In contrast, lumacaftor/ivacaftor, tezacaftor/ivacaftor, and ivacaftor monotherapy were not associated with significant changes in any assessed outcomes.

Limitations: Our analyses may underestimate the endocrine effects of CFTRm therapies, as most included papers assessed pre- and on-therapy outcomes in the same patients, potentially overlooking the gradual deterioration of glycemic control.

Conclusions: ETI therapy significantly improves glycemic control in CF, particularly when initiated at a young age. Further research is needed to confirm and detail these findings.