Pediatrics最新文献

Since 1991, the CDC has recommended screening for hepatitis B virus (HBV) infection in pregnancy and universal hepatitis B vaccination of all medically stable infants at birth, serving as a core strategy to prevent perinatal and postnatal infection and eliminate HBV transmission nationwide. On December 5, 2025, the Advisory Committee on Immunization Practices (ACIP) voted (1) among women who screen negative in pregnancy, parents decide, in consultation with providers, when or if to vaccinate their child for hepatitis B, and if not at birth, then no earlier than 2 months of age, and (2) consider collection of infant immune titers to guide decision-making for completing the vaccine series. We conducted a comprehensive review of the evidence of the safety, immunogenicity, efficacy, and effectiveness of the birth dose and a delayed first dose, and of the potential role of serology for clinical decision making. We analyzed studies of the epidemiology of HBV infection, clinical trials, systematic reviews, vaccine safety from surveillance and clinical studies, and potential impact of revised guidelines on individual and public health. We synthesized the history of ACIP recommendations and resulting trends in HBV incidence. The review found strong evidence for the safety and effectiveness of the birth dose, and no improved safety or effectiveness with a delayed first dose. We found no evidence to support use of post-vaccination serology. Infant vaccination has resulted in a 99% reduction in pediatric HBV infections; we found no evidence to support a change in vaccine recommendations but identified potential health consequences.

Background and objectives: Health-related social needs (HRSN) affect a wide range of short- and long-term outcomes, health care use, functioning, and quality of life. Although HRSN screening is valuable, it is likely ineffective unless coupled with interventions. This project integrated HRSN screening and intervention(s) across 9 inpatient and outpatient divisions, varied in composition, patient populations, process flows, and resource availability.

Methods: A quality improvement team with a standardized change package facilitated a multimodal initiative for divisions spanning hospital medicine, newborn nurseries, and specialty outpatient clinics at an urban, quaternary pediatric hospital system. We aimed for 80% of patient encounters to be screened for HRSN and that each positive screen receive an agreed upon resource intervention using a centralized resource bank.

Results: From January 2021 to October 2023, 31 834 screenings were conducted across 9 divisions. Performance increased to a mean 92%, with positive screens receiving interventions. The last 7 months of the project were sustained at 92% or higher. Food insecurity was identified in 17.6% of encounters (n = 10 007, 1765 positive), with a 56% decrease in prevalence on repeat screening after identification/intervention.

Conclusions: A centralized quality team and change package can facilitate successful implementation of HRSN screening and connection to resources across multiple disciplines and sites. These interventions may lead to a decrease in subsequent HRSN positivity. Rescreening patients over time is important to capture the full spectrum of HRSN needs of a family.

Background: Evidence on the association between maternal diabetes and neurodevelopmental disorders in offspring, particularly epilepsy, remains limited and heterogeneous. Moreover, most studies have not distinguished among diabetes subtypes-type 1 (T1DM), type 2 (T2DM), and gestational diabetes mellitus (GDM)-which have distinct etiologies. This study examines the association among these diabetes subtypes and epilepsy in offspring.

Methods: In a retrospective birth cohort of all in-hospital live births between 2002 and 2018 in Ontario, Canada's most populous province, linked with population maternal and child health records up until March 2020, we estimated the crude and adjusted association among T1DM, T2DM, and GDM and epilepsy in children aged younger than 18 years using Cox proportional hazards models. We examined the robustness of results using quantitative bias analyses.

Results: Among 2 105 553 children, 160 644 (7.6%) were exposed to maternal diabetes (0.3% T1DM, 1.2% T2DM, and 6.1% GDM). Over a median follow-up of 10.2 years, 17 853 epilepsy cases were diagnosed. After adjusting for maternal socioeconomic and clinical characteristics, children exposed to maternal diabetes had an increased risk of epilepsy in all subcategories of diabetes compared with those unexposed (adjusted HR [aHR] for T2DM, 1.40; 95% CI, 1.24-1.58; aHR for T1DM, 1.32; 95% CI, 1.03-1.69; and aHR for GDM, 1.14; 95% CI, 1.07-1.22). A longer duration of T1DM or T2DM was associated with an increased risk. These results were consistent in our quantitative bias analyses.

Conclusion: Maternal diabetes, particularly T1DM and T2DM, is associated with an increased epilepsy risk in offspring, with longer disease duration not significantly amplifying this risk. These findings suggest that prenatal metabolic and inflammatory exposures may contribute to the development of epilepsy.

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.