Pediatrics最新文献

Objectives: Youth use of GLP-1RAs is increasing. This study described GLP-1RA prescription patterns and barriers to treatment at a pediatric integrated weight management clinic.

Methods: This retrospective cohort included youth 12 to 17 years with BMI at least 95th% for age and sex, with at least 1 visit at an integrated weight management program from January 2023 to August 2025. We identified youth with at least 1 GLP-1RA prescription in the electronic health record. We assessed demographic factors (age, sex, race, ethnicity, insurance payer, preferred language) and health factors (BMI, Type 2 diabetes, results of ALT, cholesterol, and hemoglobin A1c testing). Logistic regression assessed for an association between GLP-1RA prescription and demographic and health factors. Manual medical record review of a subsample of 102 youth with GLP-1RA prescriptions described reasons for interruptions in use.

Results: Of 1647 youth, 325 (20%) had at least 1 GLP-1RA prescription. Odds of prescription increased with increasing age, increasing BMI, abnormal laboratory testing results, and non-Hispanic white or Hispanic race and ethnicity (compared with non-Hispanic Black). Odds of a prescription decreased with a preferred language other than English. In medical record review, 65 youth (64%) experienced GLP-1RA treatment interruptions, most commonly related to cost and insurance coverage.

Conclusions: At one institution's integrated weight management program, 20% of potentially eligible youth were prescribed GLP-1RAs. Prescriptions were more likely for older patients and those with comorbid conditions, and less likely for Black or non-English speaking patients, reflecting known pediatric health disparities. Barriers to treatment were common after the prescription.

Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a novel pharmacotherapeutic option for pediatric type 2 diabetes (T2D); however, little is known about their current use. This study evaluated trends in GLP-1RA dispensing in youth with T2D between 2020 and 2023 and compared use by insurance type (ie, Medicaid vs commercial).

Methods: We conducted a multiyear cross-sectional study of youth aged 10 to 17 years with T2D using Merative™ MarketScan® Multi-State Medicaid and Commercial Database claims and encounters data (2020-2023). Annual prevalence of GLP-1RA dispensing was calculated for each year. Temporal trends in dispensing were examined using the Cochran-Armitage test. Poisson regression with robust variance estimated adjusted prevalence ratios (aPRs) were used to evaluate associations between insurance type (ie, Medicaid vs commercial) and GLP-1RA dispensing in 2023.

Results: Annual prevalence of GLP-1RA dispensing in youth with T2D increased from 10.9% in 2020 to 35.6% in 2023 (P value for trend < .001) but remained less frequent than long- (49.5%) and short-acting insulin (43.4%). In 2023, overall GLP-1RA dispensing was similar for Medicaid-insured and commercially insured youth; however, the types of GLP-1RA differed by insurance. Medicaid-insured youth were less likely than commercially insured youth to be dispensed semaglutide (aPR 0.3, 95% CI: 0.2-0.4) and more likely to be dispensed dulaglutide (aPR 1.5, 95% CI: 1.2-2.0), exenatide (aPR 2.3, 95% CI: 1.2-4.2), or liraglutide (aPR 1.6, 95% CI: 1.2-2.1).

Conclusions: GLP-1RA dispensing increased in youth with T2D, but the type of GLP-1RA differed by insurance type. Comparative effectiveness studies and research identifying barriers to GLP-1RA use are needed to ensure optimal treatment of youth with T2D.

Objective: In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended both nirsevimab for infants aged less than 8 months and RSVpreF vaccine for pregnant patients at 32 to 36 weeks' gestation to prevent respiratory syncytial virus (RSV)-associated lower respiratory tract infections in infants. We compared the cost-effectiveness of the ACIP-recommended mixed nirsevimab and RSVpreF strategy vs a nirsevimab-only strategy for healthy, low-risk infants in the United States.

Methods: A decision tree with nested Markov models compared 3 immunization strategies for healthy low-risk infants: no immunization, a mixed strategy of RSVpreF and nirsevimab per ACIP guidelines, and nirsevimab only for all infants. We estimated health and societal outcomes using quality-adjusted life years (QALYs) and costs from a health care sector perspective (ie, direct medical costs) and a societal perspective (ie, factors like caregiver productivity loss). We assessed cost-effectiveness using incremental cost-effectiveness ratios (ICERs) and a willingness-to-pay threshold of $150 000/QALY to benchmark cost-effectiveness and conducted sensitivity analyses.

Results: From the health care sector perspective, neither the mixed strategy nor the nirsevimab-only strategy was cost-effective compared with no immunization, according to the $150 000/QALY threshold. From the societal perspective, the mixed strategy was cost-effective compared with no immunization ($117 848/QALY). Due to higher product costs, nirsevimab alone was not cost-effective compared with the mixed strategy ($347 821/QALY). However, if RSVpreF was not an option, the nirsevimab-only strategy would be cost-effective compared with no immunization ($134 391/QALY). Results were sensitive to assumptions about product costs and efficacy.

Conclusion: Pediatricians and obstetricians should jointly recommend RSV immunizations, as the ACIP-recommended mixed RSVpreF and nirsevimab strategy is a societally cost-effective method to protect infants.

Confidentiality protection in health care fosters patient-physician trust and encourages the disclosure of sensitive health information. According to the American Academy of Pediatrics, respecting adolescent confidentiality for certain health information, when appropriate, is imperative for the well-being of adolescents. However, challenges to establishing confidentiality in health information technology include limited technological capabilities and varying state laws. There is a need for guidance on how to promote confidentiality for sensitive electronic health information while remaining compliant with federal rules on information sharing. This policy statement reviews the current challenges and provides guiding principles and recommendations for electronic health record developers, informaticists, clinicians, and policy makers on how to create an environment that promotes trust through the protection of confidentiality for adolescent patients.

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.