Pediatrics最新文献

Objectives: To determine parent perspectives on (1) the connection between voting and child health and (2) the best ways for clinicians to promote voter engagement among patients and their families.

Methods: Qualitative study with semistructured interviews. Parents or guardians of all patients of academic pediatric primary care offices at a large, urban children's hospital in the Midwestern United States were invited to participate by email. Participants completed demographic and voting habits surveys. Trained coders independently analyzed transcripts using iterative, thematic, inductive open coding.

Results: We conducted 22 interviews. Most participants were female (91%), Black (55%), and non-Hispanic (95%). Participants represented a variety of education levels, political perspectives, and degrees of civic participation. Themes on the connection between voting and child health included the following: (1) voting helps "make your community a better place" for children now and in the future; (2) voting impacts funding for services that affect child health; and (3) voting influences our social environment, which in turn impacts child health. Themes on recommendations for health care-based voter engagement included the following: (4) consider context about voting messaging (eg, provide context about connection with health); (5) provide a variety of communication media options for delivering voting information; and (6) include a variety of health care staff in delivering voting messages.

Conclusions: In this qualitative study, we captured parent perspectives on the connection between voting and child health and desired methods for health care-based voter engagement. Our findings can inform future hypotheses for testing the mechanisms underlying established connections between voting and child health outcomes.

An atraumatic subdural hematoma (SDH) in a pediatric patient is a rare clinical entity. Although the United States Food and Drug Administration lists SDH as a possible adverse effect of adalimumab therapy for rheumatoid arthritis, the literature lacks reports of SDH in patients on adalimumab. A boy aged 16 years old with a history of ulcerative colitis on adalimumab presented with headache and a right pronator drift. Imaging demonstrated a 2.4-cm SDH on the left with 1.4 cm of midline shift. The patient underwent craniotomy and SDH evacuation, which revealed chronic SDH fluid and subdural membranes. Imaging and culture results did not suggest any other etiology (trauma, vascular malformations, infectious etiologies, or posterior reversible encephalopathy syndrome). The patient was transitioned from adalimumab therapy to ustekinumab therapy and did well without any recurrence.

Background and objectives: Boarding for pediatric mental health (MH) conditions is common at US children's hospitals while patients await care at a psychiatric facility. We sought to describe recent trends in boarding encounters and to identify factors associated with prolonged length of stay.

Methods: We performed a retrospective cross-sectional study analyzing pediatric MH boarding encounters at 40 tertiary children's hospitals included in the Pediatric Health Information System database between January 1, 2017, and December 31, 2023. Children ages 3 to 18 presenting with a primary psychiatric diagnosis were included in the analysis. We assessed trends in boarding encounters and length of stay over time and analyzed variations in boarding practices among hospitals. Risk factors for prolonged boarding (≥9 days) were identified using mixed effects logistic regression models.

Results: Between 2017 and 2023, there were 100 784 boarding encounters across 40 hospitals. Median length of stay for boarding encounters increased from 3 to 4 days (P < .001) and 350 (0.3%) children had stays of longer than 100 days. Boarding practices varied significantly by hospital site. Factors associated with prolonged boarding included older age, government insurance type, increasing medical complexity, specific psychiatric disorder, season of presentation, and discharge disposition to home.

Conclusions: Boarding while awaiting acute psychiatric care remains common, with a sustained increase in the volume of boarding encounters and length of stay since the onset of the COVID-19 pandemic. Patients with medical and/or psychiatric complexity may be more likely to experience prolonged boarding, highlighting an area for improved access to care.

Background: Primary care is an important setting to identify and support children who are eligible but not enrolled in the Supplemental Nutrition Assistance Program (SNAP) (the SNAP Gap), although there is concern that these programs may be limited in reach. We sought to identify patterns of health care use among eligible but unenrolled children.

Methods: We conducted a cross-sectional analysis of the 2021 Medical Expenditure Panel Survey. We identified 975 SNAP eligible/nonenrolled children with household incomes less than 200% of federal poverty level. SNAP eligibility was modeled using income, employment, and household composition and SNAP enrollment was self-reported. We categorized health care encounters across 9 visit types and calculated annual primary care attendance rates. Multivariable logistic regression was used to measure associations with race, language, and chronic conditions.

Results: SNAP eligible/nonenrolled children received an average of 6.04 health care encounters in 2021. Only half (52.9%) received a primary care visit. Primary care attendance was lowest for Black children (odds ratio [OR] = 0.40 [95% CI 0.20-0.81], P = .01), children speaking languages other than English (OR = 0.53 [95% CI 0.32-0.89], P = .02) and children without a chronic condition (OR = 0.08 [95% CI 0.04-0.15], P < .001). Visits to medical specialists (20.4% of all visits), behavioral health clinicians (10.9%), and dentists (10.0%) were the most common nonprimary care services received by SNAP eligible/nonenrolled children.

Conclusion: In a nationally representative sample of children who were potentially eligible but nonenrolled in SNAP, we found low primary care attendance in 2021 with evidence of racial and linguistic disparities. Clinicians beyond the primary care system are well-positioned to support children who jointly underuse government nutrition programs and primary care services.

Objective: To evaluate the effectiveness and risks of probiotics among infants born before 34 weeks' gestation and with a birth weight less than 1000 g.

Methods: A population-based retrospective cohort study of infants born before 34 weeks' gestation and admitted to 33 Canadian Neonatal Network (CNN) units between January 1, 2016, and December 31, 2022. We excluded infants who were moribund on admission, died within the first 2 days, were admitted to CNN sites more than 2 days after birth, had major congenital anomalies, or never received enteral feeds. Logistic regression, propensity score-matched, and inverse probability of treatment weighting analyses were applied.

Results: Among 32 667 eligible infants born before 34 weeks' gestation, 18 793 (57.5%) (median [IQR] gestational age, 29 [27-31] weeks) received probiotics, and 13 874 (42.5%) (median [IQR] gestational age, 31 [29-33] weeks) did not receive probiotics. In these infants, probiotics were associated with decreased mortality rates (adjusted odds ratio [aOR], 0.62; 98.3% CI, 0.53-0.73) but not decreased rates of necrotizing enterocolitis (NEC) (aOR, 0.92; 98.3% CI, 0.78-1.09) or late-onset sepsis (aOR, 0.90; 98.3% CI, 0.80-1.01). In 7401 infants with a birth weight less than 1000 g, probiotics were associated with decreased mortality rates (aOR, 0.58; 98.3% CI, 0.47-0.71) but not decreased NEC (aOR, 0.90; 98.3% CI. 0.71-1.13) or late-onset sepsis rates (aOR, 1.01; 98.3% CI, 0.86-1.18). Probiotic sepsis occurred in 27 (1.4/1000) infants born before 34 weeks' gestation and 20 (4/1000) infants with a birth weight less than 1000 g. Three infants with probiotic sepsis died, with probiotic sepsis deemed a possible cause in 2 cases.

Conclusion: Probiotics used in Canadian neonatal units were associated with decreased mortality in infants born before 34 weeks' gestation and with a birth weight less than 1000 g with limited effects on NEC and late-onset sepsis. Probiotic sepsis was rare.

Human-centered design (HCD) is rooted in building trust with end users by developing empathetic understanding of key partners' needs, continuous engagement, and iterative solution creation and refinement. One of the core tenets of HCD in health care is that consistent end-user engagement will result in better health outcomes. Children with medical complexity (CMC), a subset of children and youth with special health care needs, are characterized by multiple chronic health care conditions and high health care use, including emergency department visits. To address the known challenges with providing high-quality care for CMC in emergency settings, emergency information forms are currently recommended to provide insights into existing health complexities at the point of care. However, these forms have faced significant implementation challenges that lead to limited stakeholder buy-in and lack of incorporation into current emergency care workflows. We present HCD as a strategy to aid in the creation and optimization of an emergency care action plan (ECAP) for CMC. The objectives of this communication are, therefore, as follows: (1) to demonstrate HCD as an accessible approach to delineate and address pediatric care challenges within a complex health care system and (2) to illustrate a commonly used HCD methodological approach to address implementation challenges of an emergency care planning tool through the creation of an ECAP for CMC.

Background and objectives: Major weather and climate disasters are increasing in frequency and severity. How often these events result in child deaths is unknown. We assessed temporal and regional trends in pediatric fatalities due to weather events in the United States over the last 21 years.

Methods: We conducted an ecological study of weather-related pediatric fatalities between 2001 and 2021 using the National Centers for Environmental Information Storm Events Database. Weather-related fatalities were compared with pediatric fatalities included in the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database. The change in the proportion of all-cause pediatric fatalities associated with weather events was assessed over time. The frequency of events occurring in regions with Pediatric Disaster Care Centers of Excellence (COE) was examined.

Results: Between 2001 and 2021, weather events were associated with 1423 pediatric fatalities. Sixty percent of fatalities occurred in male children, with a bimodal distribution in age. Flood/currents accounted for the largest proportion of fatalities (37%, n = 524), followed by cold/ice/winter weather (13%, n = 192), tornadoes (13%, n = 183), heat (12%, n = 168), and hurricanes/storms (11%, n = 155). Although no significant difference was noted in the absolute number of fatalities over time (P = .18), the proportion of all-cause pediatric fatalities associated with weather events increased (P = .006) over the course of the study. Forty-six percent of pediatric fatalities occurred in areas with an associated COE.

Conclusions: Pediatric fatalities from weather events make up an increasing proportion of childhood deaths. Expansion of health-system infrastructure for pediatric disaster planning and response may mitigate childhood deaths from weather-related disasters.