Pediatrics最新文献

Background and objectives: Vaccine doses provided outside the Advisory Committee on Immunization Practices for minimum and maximum ages of vaccination and minimum intervals between doses are considered invalid. Our objective was to quantify the prevalence of and factors associated with invalid doses among US children aged 0 to 35 months.

Methods: We analyzed provider-verified vaccination records from the nationally representative 2011-2020 National Immunization Survey-Child. We quantified the number of children with at least 1 invalid vaccine dose overall, by survey year, and by vaccine type. Among children who received vaccine doses before the minimum age or minimum dose interval, we quantified the prevalence of receiving extra doses such that series were completed with the recommended number of valid doses. We used logistic regression models to identify factors associated with receipt of an invalid vaccination.

Results: Of 161 187 children, 22 209 (weighted percent: 15.4%, 95% CI, 15.0%-15.8%) had an invalid vaccine dose. Of children with a minimum age or minimum interval invalid dose, 44.9% (95% CI, 43.2%-46.6%) received extra doses and completed the series. The highest prevalence of invalid doses was for 3-dose rotavirus (n = 5733, 4.4%), with the first dose being administered after the maximum age (n = 3996, 3.1%). Overall, the percentage of children with an invalid dose decreased from 2011 (16.9%) to 2020 (12.5%). Children who moved across state lines vs not (adjusted odds ratio: 1.5 [95% CI, 1.4-1.6]) had higher odds of an invalid vaccine dose.

Conclusions: Although invalid vaccine doses have decreased over time, many children with invalid doses lacked the doses necessary to complete a vaccine series.

Background: Traditional classification of children's and nonchildren's hospitals is based on physical structure and branding. We grouped hospitals with the most similar types of pediatric patients.

Methods: Retrospective analysis of 2.8 million hospitalizations in 3993 hospitals for patients 0 to 20 years in the 2019 Kids' Inpatient Database. After stratifying low-volume hospitals (greater than 100 annual admissions), we grouped the remaining hospitals using K-means clustering by case-mix of neonatal services and pediatric diagnosis diversity (DD).

Results: Clustering distinguished 6 hospital groups. Group 1 (n = 1665 [1.6% of hospitalizations]) represented low pediatric volume hospitals (13 annual pediatric hospitalizations [IQR 3-82]). Group 2 (n = 118 hospitals [1.1% of hospitalizations]) provided no neonatal care, had low DD (12 [IQR 4-34]), and had a median age of 17 years. Group 3 (n = 1156 [19.7% of hospitalizations]) hospitals provided low-severity neonatal care with low DD (13 [IQR 7-19). Group 4 (n = 674 hospitals, [24.0% of hospitalizations]) provided moderate-severity neonatal care (2.2 [ IQR 2.1-2.4]) and increased DD (24 [ IQR 6-34]). Group 5 (n = 238 hospitals [20.5% of hospitalizations]) had a similar severity of neonatal care as group 4 (2.3 [IQR 2.1-2.5]), but 2.7 times greater DD (64 [IQR 55-77]). Group 6 (n = 142 hospitals [33.0% of hospitalizations]) had the highest-severity neonatal care (2.6 [IQR 2.3-3.1]) and the greatest DD (127 [113-140]).

Conclusion: Children receive inpatient care across 6 groups of hospitals, distinguished by neonatal case-mix and DD. Future studies should investigate the utility of these groups for peer comparisons with health care use and outcomes.

Background and objectives: The likelihood and severity of neurodevelopmental impairment (NDI) affects critical health care decisions. NDI definitions were developed without parental perspectives. We investigated the agreement between parental vs medical classification of NDI among children born preterm.

Methods: In this multicenter study, parents of children born preterm (<29 weeks) evaluated at 18 to 21 months corrected age (CA) were asked whether they considered their child as developing normally, having mild/moderate impairment, or having severe impairment. Medical categorization was based on hearing, vision, cerebral palsy status, and Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) scores. Agreement was analyzed using Cohen's weighted κ. Discrepancies in categorization by NDI components and parental demographics were examined using the Pearson χ2 test, Fisher exact test, or Wilcoxon signed-rank test.

Results: Children (n = 1098, gestational age 26.1 ± 1.5 weeks, birthweight 919 ± 247 g) were evaluated at 19.6 ± 2.6 months CA at 13 clinics. Agreement between parental and medical NDI classification was poor (κ = 0.30; 95% CI: 0.26-0.35). Parents described their child's development as normal or less impaired. Only 12% of parents of children classified as having a severe NDI according to the medical definition agreed. There were significant disagreements between classification for children based on Bayley-III cognitive, language, and motor scores but not for cerebral palsy. Discrepancies varied by parental education and ethnicity but not by single caregiver status.

Conclusions: Parent perception of NDI differs from medical categorization, creating a risk of miscommunication. This indicates an overestimation of the impact of disability by clinicians, which may affect life-and-death decisions. Parental perspectives should be considered when reporting and discussing neurodevelopmental outcomes.

Context: Functional abdominal pain disorders (FAPDs) are debilitating disorders with unknown current prevalence.

Objective: To estimate global prevalence rates of FAPDs, their entities, and variations by diagnostic criteria, geography, gender, and age.

Data sources: Medline, Embase, CINAHL, PsycInfo, and Cochrane Library were searched through October 14, 2024.

Study selection: Epidemiological studies of birth cohorts, school based, and from general population samples reporting FAPD prevalence in children (aged 4-18 years) using the Rome criteria.

Data extraction: Two researchers independently performed screening, data extraction, and quality assessment.

Results: A total of 66 studies, encompassing 201 134 participants from 29 countries, were included. The estimated global pooled prevalence of FAPDs was 11.7% (95% CI, 10.5%-13.1%). The most prevalent type was irritable bowel syndrome (5.8%; 95% CI, 4.5-7.4%), while functional abdominal pain-not otherwise specified was least prevalent (1.2%; 95% CI, 0.7%-2.1%)). Prevalence was highest using Rome III (13.2%; 95% CI, 11.3%-15.3%) and lowest under Rome IV criteria (9.0%; 95% CI, 6.7%-12.0%; P = .05). Girls had higher prevalence (14.4%; 95% CI, 12.5%-16.6%) than boys (9.4%; 95% CI, 7.8%-11.4%; P < .01). FAPDs were nonsignificantly more prevalent in Asia (13.0%; 95% CI, 10.4%-16.3%) compared to Europe (8.3%; 95% CI, 6.4%-10.7%) and North America (7.7%; 95% CI, 4.3-13.6; P = .09). No differences by age (P = .14) were recorded. Contributing factors include anxiety, depression, stress, negative life events, and poor sleep.

Limitations: Language restrictions, significant interstudy heterogeneity, and underrepresentation from Africa.

Conclusions and relevance: FAPDs affect over 1 in 9 children worldwide, with higher prevalence in girls and those with psychological stressors.

Background and objectives: Human papillomavirus (HPV) vaccination rates are suboptimal, and missed vaccination opportunities are common. We hypothesized that a bundled intervention improves missed HPV vaccination opportunities.

Methods: We used a pre-post design to assess differences in HPV vaccine missed opportunities (visits when vaccine-eligible adolescents are not vaccinated). We compared rates for a 12-month period before vs those for a 6-month period (February 23, 2022, to August 9, 2022) during a bundled intervention. We implemented the bundled intervention in 24 primary care pediatric practices that had been usual care controls for a prior randomized trial. The bundled intervention involved 3 components: online clinician training on HPV vaccine communication, performance feedback on missed HPV vaccination opportunities, and clinician prompts for HPV vaccination. As a secondary analysis, we compared missed opportunities for these 24 practices vs 48 contemporaneous comparison group practices identified retrospectively.

Results: For well-child care (WCC) visits, missed HPV vaccination opportunities were improved during vs before the intervention by 4.8 percentage points (95% CI, -7.2% to -2.4%) for initial HPV vaccine doses and a modest 2.2 percentage points (95% CI, -4.4% to -0.0%) for subsequent doses. For other visit types, findings ruled out changes beyond minimal improvements. Missed vaccination opportunity rates for initial HPV vaccination at WCC visits were similar for the 24 intervention practices vs the 48 comparison practices for a 4.5-year period before the intervention, but they improved for intervention practices and worsened for comparison practices during the intervention period (difference, -6.6%; 95% CI, -9.3% to -3.8%).

Conclusions: This bundled intervention appeared to improve HPV vaccination during WCC visits.

Objectives: Homelessness is a public health crisis in the United States, yet homelessness prevalence, especially among children and youth, is not well understood. In this study, we use an indirect estimation method known as multiple systems estimation to further evaluate prevalence of youth experiencing homelessness in Denver, Colorado.

Methods: We performed a multiple systems estimation ("capture-recapture") analysis to estimate annual homelessness among youth aged 14 to 17 years in the city and county of Denver, Colorado from 2017 to 2021. We used 3 citywide datasets linked at the individual level and stratified by year, as follows: (1) Denver-Metro Homeless Management Information System, (2) Denver Public Schools McKinney-Vento data, and (3) Colorado's Statewide Automated Child Welfare Information System TRAILS. We identified "known" youth experiencing homelessness from the 3 datasets and developed log-linear models with calculated 95% CIs to estimate the unknown population. We combined these counts to estimate the total youth homeless population and stratified counts by race, ethnicity, and gender.

Results: The known count of youth experiencing homelessness increased from 840 in 2017 to 1040 in 2021. We estimated the total number of youth experiencing homelessness increased from 2880 (95% CI, 2199-3290) in 2017 to 7084 (95% CI, 2826-9046) in 2021. This corresponds with an increase from 10.4% to 25.1% in the total prevalence of youth experiencing homelessness in Denver. We found 74.9% to 83.1% of youth experiencing homelessness were Black/African American or Hispanic.

Conclusions: The scope of youth homelessness increased notably and may be far greater than previously understood. Using multiple systems estimation may improve homelessness prevalence estimates and facilitate more effective resource allocation and service delivery.

Pleural tuberculoma is often observed during treatment for tuberculous pleurisy; however, this condition is rarely found as a solitary pleural nodule in patients without a history of tuberculosis treatment, and no cases have been reported in children. We report a case of a 12-year-old boy with pleural tuberculoma presenting as a solitary mass. He had a fever and cough that prompted chest radiography, which revealed a mass in the right lung. Symptoms improved with antibacterial medication; however, computed tomography (CT) revealed a 4.5-cm pleural mass that partially bordered the ribs. CT-guided biopsy revealed a necrotizing granuloma, but the real-time polymerase chain reaction result for Mycobacterium tuberculosis was negative. Malignant diseases, such as osteosarcoma, could not be ruled out; thus, surgical resection was performed, and pleural tuberculoma was diagnosed. The patient was treated with antituberculosis drugs for 6 months, and no recurrence was observed in the following 2 years. Pleural tuberculomas should be considered in the differential diagnosis of solitary pleural tumors, especially in countries where tuberculosis is endemic.